Aims: The identification of the response of ventricular arrhythmias to exercise testing could provide important information in the clinical setting but is difficult to obtain as no definite criteria are available. The aim of this study was to evaluate whether analysis of spontaneous heart rate dependency of premature ventricular contractions evaluated by means of 24 h electrocardiographic monitoring is capable of predicting their behaviour during exercise.
Methods and results: One hundred and twenty-six patients (49 +/- 16 years) with frequent (> 30 h) premature ventricular contractions underwent 24 h electrocardiographic monitoring in order to evaluate the relationship between arrhythmias and heart rate, and an exercise test in order to evaluate the behaviour of the arrhythmias. On the basis of the incidence of premature ventricular contractions at different cardiac cycle lengths found at electrocardiographic monitoring, three groups of patients were identified: 34 with a tachycardia-enhanced pattern (the shorter the cycle length the higher the incidence of arrhythmias); 32 with a bradycardia-enhanced pattern (the longer the cycle length the higher the incidence of arrhythmias); and 60 patients with an indifferent pattern (no relationship). During the exercise test, the number of premature ventricular contractions/min at maximal effort in comparison with baseline increased in patients with a tachycardia-enhanced pattern (couplets or runs appeared in 10), decreased in those with a bradycardia-enhanced pattern and did not change in those with an indifferent pattern. The positive predictive accuracy of the tachycardia-enhanced pattern in predicting an increase in premature ventricular contractions > 100% at maximal effort was 78%.
Conclusion: Identification of spontaneous behaviour between the incidence of premature ventricular contractions and the length of the preceding cardiac cycle may predict the behaviour of arrhythmias during exercise.