Leenhardt A, Thomas O, Cauchemez B, Maison-Blanche P, Denjoy I, de Jode P, Kedra W, Coumel P
Service de cardiologie, hôpital Lariboisière, Paris.
Arch Mal Coeur Vaiss. 1995 Jan;88 Spec No 1:59-66.
Exercise testing may be used to assess symptoms occurring on effort, to search for and evaluate arrhythmias or conduction defects, antiarrhythmic drugs, pacemakers or implantable cardioverter defibrillators. Interpretation of exercise testing is difficult because of the complexity of the factors in play. Exercise itself induces changes in myocardial metabolism and the autonomic nervous system, the nature and importance of which are influenced by the underlying cardiac disease and the presence of cardiac failure or myocardial ischaemia. This is particularly true when studying the behaviour of arrhythmias on effort, which depends on many parameters, in that they may appear or disappear during exercise, irrespective of their relationship to autonomic nervous system activation. The main problem lies in the interpretation of changes in the heart rate before the onset of an arrhythmia. The sinus rhythm is both a passive indicator of the vago-sympathetic equilibrium and one of the determining factor of the arrhythmia (relationship to the rate), but it is, itself, dependent on the presence of myocardial dysfunction, a source of arrhythmias, and its changes then become difficult to interpret. These reasons explain why exercise testing is certainly a valuable tool in assessing arrhythmias but the poor reproducibility, especially in the evaluation of ventricular arrhythmias, advises prudence in the interpretation of results.
运动试验可用于评估运动时出现的症状，寻找并评估心律失常或传导缺陷、抗心律失常药物、起搏器或植入式心脏复律除颤器。由于运动试验中涉及的因素复杂，其结果解读存在困难。运动本身会引起心肌代谢和自主神经系统的变化，而这些变化的性质和重要性受到潜在心脏病以及心力衰竭或心肌缺血的影响。在研究运动时心律失常的表现时尤其如此，运动时心律失常的表现取决于许多参数，因为它们可能在运动期间出现或消失，而与自主神经系统激活无关。主要问题在于心律失常发作前心率变化的解读。窦性心律既是迷走-交感神经平衡的被动指标，也是心律失常的决定因素之一（与心率的关系），但其本身又依赖于心肌功能障碍的存在，而心肌功能障碍是心律失常的一个来源，因此其变化难以解读。这些原因解释了为什么运动试验无疑是评估心律失常的一项有价值的工具，但由于其重复性差，尤其是在评估室性心律失常方面，所以在解读结果时应谨慎。
