Pitzalis M V, Mastropasqua F, Massari F, Passantino A, Totaro P, Forleo C, Rizzon P
Institute of Cardiology, University of Bari, Italy.
Eur Heart J. 1997 Oct;18(10):1642-8. doi: 10.1093/oxfordjournals.eurheartj.a015145.
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.
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%.
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.
确定室性心律失常对运动试验的反应可为临床提供重要信息，但由于缺乏明确标准，很难获得该信息。本研究旨在评估通过24小时心电图监测评估的室性早搏自发心率依赖性分析是否能够预测其在运动期间的表现。
126例（49±16岁）频发（>30次/小时）室性早搏患者接受24小时心电图监测，以评估心律失常与心率之间的关系，并进行运动试验以评估心律失常的表现。根据心电图监测发现的不同心动周期长度下室性早搏的发生率，将患者分为三组：34例呈心动过速增强型（周期长度越短，心律失常发生率越高）；32例呈心动过缓增强型（周期长度越长，心律失常发生率越高）；60例呈无差异型（无关系）。在运动试验期间，与基线相比，心动过速增强型患者最大运动时每分钟室性早搏数量增加（10例出现成对或连续早搏），心动过缓增强型患者数量减少，无差异型患者数量无变化。心动过速增强型在预测最大运动时室性早搏增加>100%方面的阳性预测准确率为78%。
确定室性早搏发生率与前一心动周期长度之间的自发行为可预测运动期间心律失常的表现。
