Electrocardiographic patterns of exercise-induced ventricular arrhythmias in patients with and without coronary artery disease

Öz

Objectives: This study was carried out to compare the electrocardiographic characteristics of exercise-induced ventricular arrhythmias (EIVA) in patients with and without coronary artery disease (CAD). Methods: The exercise tests of patients who were diagnosed to have EIVA and also underwent coronary angiography were analyzed retrospectively. The electrocardiographic patterns of EIVA in patients with and without CAD were compared. Results: The most common EIVA was premature ventricular contractions (PVCs) with left bundle-branch block (LBBB) pattern and inferior axis in both groups (63% in normal coronary artery (NCA) group and 59% in CAD group). PVCs with right bundle-branch block (RBBB) pattern and superior axis (33% vs. 17%, p=0.001) and the presence of multifocal PVC were found to be more frequent in CAD group (23% vs. 7%, p

Anahtar Kelimeler

• Coronary artery disease, exercise test, ventricular arrhythmias

Koroner arter hastalığı olan ve olmayan hastalarda egzersize bağlı ventriküler aritminin elektrokardiyografik özellikleri

Öz

Amaç: Bu çalışma, koroner arter hastalığı (KAH) olan ve olmayan hastalarda egzersize bağlı ventriküler aritmi (EBVA) ve elektrokardiyografik özelliklerini karşılaştırmak amacıyla yapılmıştır. Yöntemler: Egzersiz testinde EBVA tespit edilen ve aynı zamanda koroner anjiyografi uygulanan hastalar geriye dönük olarak incelendi. KAH olan ve olmayan hastaların EBVA\'larının elektrokardiyografik özellikleri incelendi. Bulgular: Her iki hasta grubunda da en sık görülen EBVA, sol dal bloğu (LBBB) ve inferiyor eksen içeren erken ventriküler atımlar (EVA) idi (Normal koroner arter (NKA) grubunda % 63 ve KAH grubunda % 59). Sağ dal bloğu (RBBB) ve superiyor eksen şeklindeki EVA (%33 vs. %17, p=0,001) ve multifokal EVA, KAH grubunda daha sık bulundu (% 23 vs. % 7, p

Anahtar Kelimeler

• Egzersiz testi, koroner arter hastalığı, ventriküler aritmi

Kaynakça

1. Beckerman J, Wu T, Jones S, Froelicher VF. Exer- cise test-induced arrhythmias. Prog Cardiovasc Dis 2005;47:285-305.
2. Candinas RA, Podrid PJ. Evaluation of cardiac arrhyth- mias by exercise testing. Herz 1990;15:21-27.
3. Weiner DA, Ryan TJ, McCabe CH, et al. Prognostic im- portance of a clinical profile and exercise test in medi- cally treated patients with coronary artery disease. J Am Coll Cardiol 1984;3:772-779.
4. Casella G, Pavesi PC, Sangiorgio P, et al. Exercise-in- duced ventricular arrhythmias in patients with healed myocardial infarction. Int J Cardiol 1993;40:229-235.
5. Busby MJ, Shefrin EA, Fleg JL. Prevalence and long- term significance of exercise-induced frequent or re- petitive ventricular ectopic beats in apparently healthy volunteers. J Am Coll Cardiol 1989;14:1659-1665.
6. Fleg JL, Lakatta EG. Prevalence and prognosis of exercise-induced non-sustained ventricular tachy- cardia in apparently healthy volunteers. Am J Cardiol 1984;54:762-724.
7. Faris JV, McHenry PL, Jordan JW, Morris SN. Preva- lence and reproducibility of exercise-induced ventric- ular arrhythmias during maximal exercise testing in normal men. Am J Cardiol 1976;37:617-622.
8. Sami M, Chaitman B, Fisher L, et al. Significance of exercise-induced ventricular arrhythmia in stable cor- onary artery disease: a coronary artery surgery study project. Am J Cardiol 1984;54:1182-1188.

9. Elhendy A, Chandrasekaran K, Gersh BJ, et al. Func- tional and prognostic significance of exercise-induced ventricular arrhythmias in patients with suspected cor- onary artery disease. Am J Cardiol 2002;90:95-100.
10. Eckart RE, Field ME, Hruczkowski TW, et al. Associa- tion of electrocardiographic morphology of exercise- induced ventricular arrhythmia with mortality. Ann In- tern Med 2008;149:451-60, W82.
11. Dixit S, Gerstenfeld EP, Callans DJ, Marchlinski FE. Electrocardiographic patterns of superior right ventric- ular outflow tract tachycardias: distinguishing septal and free-wall sites of origin. J Cardiovasc Electro- physiol 2003;14:1-7.
12. Rasouli ML, Ellestad MH. Usefulness of ST depres- sion in ventricular premature complexes to predict myocardial ischemia. Am J Cardiol 2001;87:891-4.
13. Partington S, Myers J, Cho S, et al. Prevalence and prognostic value of exercise-induced ventricular ar- rhythmias. Am Heart J 2003;145:139-146.
14. Beckerman J, Mathur A, Stahr S, et al. Exercise- induced ventricular arrhythmias and cardiovascular death. Ann Noninvasive Electrocardiol 2005;10:47-52.
15. Califf RM, McKinnis RA, McNeer JF, et al. Prognostic value of ventricular arrhythmias associated with tread- mill exercise testing in patients studied with cardiac catheterization for suspected ischemic heart disease. J Am Coll Cardiol 1983;2:1060-1067.
16. Morshedi-Meibodi A, Evans JC, Levy D, et al. Clini- cal correlates and prognostic significance of exer- cise-induced ventricular premature beats in the com- munity: the Framingham Heart Study. Circulation 2004;109:2417-2422.
17. Jouven X, Zureik M, Desnos M, et al. Long-term out- come in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med 2000;343:826-833.
18. Mora S, Redberg RF, Cui Y, et al. Ability of exer- cise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA 2003;290:1600-1607.
19. Drory Y, Pines A, Fisman EZ, Kellermann JJ. Per- sistence of arrhythmia exercise response in healthy young men. Am J Cardiol 1990;66:1092-1094.
20. Morrow K, Morris CK, Froelicher VF, et al. Prediction of cardiovascular death in men undergoing noninva- sive evaluation for coronary artery disease. Ann Intern Med 1993;118:689-695.
21. Trejo R, Sierra I, Ferez S, Cardenas M. [Predictive value of ventricular extrasystole in the exertion test and its relation to the magnitude of coronary damage]. Arch Inst Cardiol Mex 1986;56:255-258.
22. Schweikert RA, Pashkow FJ, Snader CE, et al. Asso- ciation of exercise-induced ventricular ectopic activity with thallium myocardial perfusion and angiographic coronary artery disease in stable, low-risk popula- tions. Am J Cardiol 1999;83:530-4.
23. Rodriguez LM, Waleffe A, Brugada P, et al. Exercise- induced sustained symptomatic ventricular tachycar- dia: incidence, clinical, angiographic and electrophysi- ologic characteristics. Eur Heart J 1990;11:225-232.
24. Gooch AS. Exercise testing for detecting changes in cardiac rhythm and conduction. Am J Cardiol 1972; 30:741-746.
25. Palileo EV, Ashley WW, Swiryn S, et al. Exercise pro- vocable right ventricular outflow tract tachycardia. Eur Heart J 1982;104:185-193.
26. Codini MA, Sommerfeldt L, Eybel CE, Messer JV. Clinical significance and characteristics of exercise- induced ventricular tachycardia. Cathet Cardiovasc Diagn 1981;7:227-234.
27. Milanes J, Romero M, Hultgren HN, Shettigar U. Ex- ercise tests and ventricular tachycardia. West J Med 1986; 145:473-476.
28. Tamakoshi K, Fukuda E, Tajima A, et al. [Prevalence and clinical background of exercise-induced ventric- ular tachycardia during exercise testing]. J Cardiol 2002;39:205-212.
29. Biffi A. How to manage athletes with ventricular ar- rhythmias. Cardiol Clin 2007;25:449-455.