Survival is decreased when frequent ventricular ectopy follows exercise testing (NEJM 2003: 348:781)
Froklis et al at the Cleveland Clinic found that frequent ventricular ectopy after exercise tests have an increased death rate (9 vs 5 percent death rate at 5 year follow up). This was derived from a study of over 29,000 patients referred for a symptom limited stress test who did not have a history of heart failure, valve disease or arrhythmia.
Definition: Frequent ventricular ectopy was defined as > 7 PVC/minute, bi or trigeminy, couplets, triplets, ventricular tachycardia, flutter, torsade, or fibrillation. Patients with the most severe ventricular ectopy (triplets or worse) had the greatest 5 year mortality (11%).
Patients with frequent ventricular ectopy during exercise only had slightly worsened survival, but this was not independent of other risk factors such as old age, male sex, diabetes,smoking, reduced exercise tolerance, and abnormal heart rate recovery. Alternatively, frequent recovery ectopy was an independent predictor of increased death rate. The mechanism may, like abnormal heart rate recovery, relate to reduced return of vagal tone post exercise.
For more information, the article may be found at www.nejm.org.
