[Diagnostic value of exercise test in the evaluation of sustained ventricular arrhythmia]

The authors undertook a prospective study comparing exercise testing and programmed ventricular stimulation in order to assess the diagnostic value and risks of exercise stress testing in patients with sustained ventricular arrhythmias. Fifty-five consecutive patients (47 men and 8 women) with an average age of 47 +/- 15 years were included. The initial condition requiring investigation was sustained ventricular tachycardia (47 cases) and ventricular fibrillation (8 cases). The patients had ischaemic heart disease (N = 18), dilated cardiomyopathy (N = 9), valvular heart disease (N = 4) and congenital heart disease (N = 3). Six patients presented with arrhythmogenic right ventricular dysplasia and 15 patients had apparently normal hearts. Four episodes of sustained ventricular tachycardia (7.3%) and 10 non-sustained ventricular tachycardia (18.2%) were induced by exercise testing. One poorly tolerated episode of ventricular tachycardia required cardioversion. No signs of myocardial ischaemia were observed in association with the induced ventricular tachycardia Patients with ventricular tachycardia induced by exercise were significantly younger (39.5 +/- 12.5 vs 49.5 +/- 15.4 years; p = 0.04) and attained a lower predicted maximal heart rate (82.2 +/- 14.6 vs 91.4 +/- 14.4%; p = 0.04), but the underlying pathologies were the same, as were the initial arrhythmias and the level of exercise attained. With respect to the clinical circumstances of induction of the initial ventricular arrhythmia, patients with ventricular tachycardia induced by exercise had an increased tendency to arrhythmias during effort or stress (7/14 vs 8/41; p = 0.06). Programmed ventricular stimulation induced more ventricular tachycardias than exercise testing (36/55 vs 14/55; p < 0.0001). The results of exercise testing were not correlated to those of programmed stimulation (p = 0.38).(ABSTRACT TRUNCATED AT 250 WORDS)