Incidence and complexity of ventricular ectopy during Holter monitoring in patients with exercise-induced myocardial ischemia and normal or mildly reduced left ventricular function.

We aimed to assess the relationship between frequent and complex ventricular ectopy by continuous electrocardigraphic 24-hours Holter monitoring in patients with coronary artery disease and inducible ischemia during exercise procedures. We investigated 609 consecutive patients. They were referred for chest pain (28% with a previous myocardial infarction, older than 6 months). In all population patients radionuclide ventriculography showed a global normal or mildly reduced left ventricular function (ejection fraction > 45%). All patients showed exercise-induced myocardial ischemia (ST depression) and exercise thallium-201 reversible defects. During Holter monitoring, in study population, divided according to incidence of premature ventricular complexes (PVC), we found a higher prevalence of complex ventricular arrhythmias (CVA) (bigeminy, couplets, ventricular tachycardia, multiformity) in patients with high incidence of PVC. The relationship between frequent and complex ventricular ectopy has been observed also during ischemic ST shifts occuring during 24-hours monitoring. In contrast, the R on T phenomenon was not related to incidence of PVC. Therefore, in patients with exercise-induced myocardial ischemia and global normal or mildly reduced left ventricular function there is a relationship between frequent and complex ventricular ectopy, as previously suggested in CAD patients with depressed left ventricular function.