Diagnostic value of exercise testing versus long-term ECG in evaluation of arrhythmias in old age

The usefulness of exercise testing (ET) in old age is so far undefined particularly for detection of arrhythmias. We compared the diagnostic value of ET with 24-h long-term ECG recording (LT-ECG) in patients older than 70 years that were evaluated because of symptoms possibly related to arrhythmias. In 37 patients (age 72.8 +/- 2.7 years) the incidence of ventricular arrhythmias (LOWN greater than or equal to 1) was greater during ET (67%) than during 24-h LT-ECG recording (48%, P less than 0.01). Complex ventricular arrhythmias were detected in 6/37 patients (16%) by ET, in 9/37 patients (24%) by LT-ECG, in one patient (3%) by both tests and in 14/37 patients (37%) by one of the two tests, while 23/37 patients (63%) had no significant complex arrhythmias recorded by either test. During ET 12 patients (32%) showed signs of myocardial ischaemia with ST-depression greater than or equal to 0.2 mV and/or increasing angina pectoris. In 42% of these patients complex ventricular arrhythmias LOWN greater than or equal to 3 occurred during ET. Thus both ET and LT-ECG are useful methods to uncover arrhythmias in symptomatic patients older than 70 years and have to be considered as complementary tools.