Department of Clinical and Experimental Cardiology, Heart Center (K.V.V.L., C.v.d.W., N.H., S.-A.B.C., A.A.M.W.), the Netherlands.
European Reference Network 'ERN GUARD-Heart' (K.V.V.L., V.D., C.v.d.W., A.D., I.D., H.B., F.R.I.N., T.R., N.H., J.T., J.T.-H., V.P., A.L., H.S., P.J.S., A.A.M.W.).
Circ Arrhythm Electrophysiol. 2020 Mar;13(3):e007471. doi: 10.1161/CIRCEP.119.007471. Epub 2020 Feb 16.
Risk stratification in catecholaminergic polymorphic ventricular tachycardia remains ill defined. Heart rate recovery (HRR) immediately after exercise is regulated by autonomic reflexes, particularly vagal tone, and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Our objective was to evaluate whether HRR after maximal exercise on the exercise stress test (EST) is associated with symptoms and ventricular arrhythmias.
In this retrospective observational study, we included patients ≤65 years of age with an EST without antiarrhythmic drugs who attained at least 80% of their age- and sex-predicted maximal HR. HRR in the recovery phase was calculated as the difference in heart rate (HR) at maximal exercise and at 1 minute in the recovery phase (ΔHRR1').
We included 187 patients (median age, 36 years; 68 [36%] symptomatic before diagnosis). Pre-EST HR and maximal HR were equal among symptomatic and asymptomatic patients. Patients who were symptomatic before diagnosis had a greater ΔHRR1' after maximal exercise (43 [interquartile range, 25-58] versus 25 [interquartile range, 19-34] beats/min; <0.001). Corrected for age, sex, and relatedness, patients in the upper tertile for ΔHRR1' had an odds ratio of 3.4 (95% CI, 1.6-7.4) of being symptomatic before diagnosis (<0.001). In addition, ΔHRR1' was higher in patients with complex ventricular arrhythmias at EST off antiarrhythmic drugs (33 [interquartile range, 22-48] versus 27 [interquartile range, 20-36] beats/min; =0.01). After diagnosis, patients with a ΔHRR1' in the upper tertile of its distribution had significantly more arrhythmic events as compared with patients in the other tertiles (=0.045).
Catecholaminergic polymorphic ventricular tachycardia patients with a larger HRR following exercise are more likely to be symptomatic and have complex ventricular arrhythmias during the first EST off antiarrhythmic drug.
儿茶酚胺多形性室性心动过速的风险分层仍不明确。运动后即刻的心率恢复（HRR）受自主反射调节，尤其是迷走神经张力，与儿茶酚胺多形性室性心动过速患者的症状和室性心律失常有关。我们的目的是评估运动应激试验（EST）中最大运动后的 HRR 是否与症状和室性心律失常相关。
在这项回顾性观察研究中，我们纳入了年龄≤65 岁、EST 时未使用抗心律失常药物且达到年龄和性别预测最大心率 80%的患者。在恢复期，通过最大运动时和恢复期 1 分钟时的心率（HR）差计算 HRR，即 HRR1'。
共纳入 187 例患者（中位年龄 36 岁；68 例[36%]在诊断前有症状）。在诊断前有症状的患者与无症状患者的预 EST 心率和最大 HR 相同。在诊断前有症状的患者在最大运动后 HRR1'更大（43[四分位间距，25-58]与 25[四分位间距，19-34]次/分；<0.001）。校正年龄、性别和亲缘关系后，HRR1'在上三分位的患者在诊断前有症状的比值比为 3.4（95%可信区间，1.6-7.4）（<0.001）。此外，在 EST 停用抗心律失常药物时，有复杂室性心律失常的患者 HRR1'更高（33[四分位间距，22-48]与 27[四分位间距，20-36]次/分；=0.01）。诊断后，HRR1'分布在上三分位的患者与分布在其他三分位的患者相比，心律失常事件明显更多（=0.045）。
与其他三分位相比，运动后 HRR 较大的儿茶酚胺多形性室性心动过速患者在首次 EST 停用抗心律失常药物时更可能出现症状和有复杂室性心律失常。
