Utility of the Exercise Electrocardiogram Testing in Sudden Cardiac Death Risk Stratification

Abstract

Background: Sudden cardiac death (SCD) remains a major public health problem. Current established criteria identifying those at risk of sudden arrhythmic death, and likely to benefit from implantable cardioverter defibrillators (ICDs), are neither sensitive nor specific. Exercise electrocardiogram (ECG) testing was traditionally used for information concerning patients' symptoms, exercise capacity, cardiovascular function, myocardial ischemia detection, and hemodynamic responses during activity in patients with hypertrophic cardiomyopathy.Methods: We conducted a systematic review of MEDLINE on the utility of exercise ECG testing in SCD risk stratification.Results: Exercise testing can unmask suspected primary electrical diseases in certain patients (catecholaminergic polymorphic ventricular tachycardia or concealed long QT syndrome) and can be effectively utilized to risk stratify patients at an increased (such as early repolarization syndrome and Brugada syndrome) or decreased risk of SCD, such as the loss of preexcitation on exercise testing in asymptomatic Wolff-Parkinson-White syndrome.Conclusions: Exercise ECG testing helps in SCD risk stratification in patients with and without arrhythmogenic hereditary syndromes.

Cardiac Channelopathies and Sudden Death: Recent Clinical and Genetic Advances

“…Diagnostic characteristics of CPVT are unmasked by exercise ECG [168] (Figure 5). Usually, the beginning of ventricular arrhythmias is 100–120 beats/min [169].…”

Validation of the Heart:Rate Signal Provided by the Zephyr BioHarness 3.0

“…Indeed, abnormalities in cardiac repolarization, identifiable by analyzing the electrocardiographic ST segment and T wave [4][5][6], are also known to be linked to an increased risk of developing malignant ventricular arrhythmias that may degenerate in SCD [7][8][9]; and mean HR (MHR) and HR variability (HRV) parameters, obtained by analyzing the HRS, are universally recognized as indicators of SCD [10,11]. Monitoring of repolarization and HR indexes is usually performed by medical evaluation of standard ECG tracings or Holter ECG recordings, which require the subject to visit hospitals or doctor offices [12][13][14]. In case of transient abnormal cardiac episodes, such recordings may likely not include them.…”

Understanding the ECG. Part 5: Pre-excitation

“…A more useful indicator appears to be loss of AP conduction at higher heart rates (Refaat et al, 2014). A simple exercise test can be used to determine this.…”