Complete atrioventricular block during exercise: New insights from an old test

Abstract

Exercise stress testing can have a central role in the assessment of cardiovascular disease. Contemporary data, however, has highlighted the added value of imaging modalities over the exercise electrocardiogram in the investigation of coronary artery disease. Given the physiological changes associated with exercise and the possibility to address other parameters such as rhythm changes and the chronotropic response, exercise stress testing with continuous electrocardiographic monitoring can still have an important place in contemporary clinical practice. We report the case of a complete atrioventricular block associated with exercise and discuss the current role of exercise stress testing with continuous electrocardiographic monitoring in this entity.

Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring

“… 15 , 39 , 61 An example of this can be illustrated in the reproduction of symptoms with the development of advanced heart block during exercise testing, thus providing a correlation between symptoms and conduction anomalies. 88 The ESC guidelines on cardiac pacing and cardiac resynchronization therapy recommend exercise testing in those presenting symptoms compatible with bradycardia during (or immediately after) exertion (class I, level C recommendation) while the ACC/AHA/HRS guidelines state that this is reasonable in this setting (class IIa, level C recommendation). 15 , 61 These notions are also echoed in the recommendations for those with syncope, which albeit recalling that exercise testing should not be performed in all cases, highlight that it should be considered in those with syncope during (or immediately after) exercise (class I, level C recommendation in the ESC guidelines on this subject).…”