| Ventricular ectopy during treadmill exercise stress testing in the evaluation of long QT syndrome. | |
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MedLine Citation:
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PMID: 19084807 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Long QT syndrome (LQTS) can present with sudden death during exertion. OBJECTIVE: The purpose of this study was to determine the diagnostic importance of exercise-induced ventricular ectopy in the evaluation of LQTS. METHODS: From 1998 to 2006, 381 patients with a referral diagnosis of LQTS underwent a treadmill exercise stress test. An investigator blinded to both genotype and rendered diagnosis scored the stress tests for the presence of exercise-induced ventricular ectopy. RESULTS: The dismissal diagnosis was LQTS in 177 (46%), catecholaminergic polymorphic ventricular tachycardia (CPVT) in 16, miscellaneous cardiac disease in 17, and normal in 171. Exercise-induced ventricular ectopy was detected in 107 (28%) patients. However, only 34 patients (9% overall) had exercise-induced ventricular ectopy greater than single premature ventricular contractions (PVCs). Among the 171 patients dismissed as normal, only 2% had ectopy greater than single PVCs. Among the genotype-positive LQTS patients, no significant ectopy was recorded in 80 with LQT1, compared to 5 (8%) patients with LQT2 and 3 (20%) patients with LQT3 (P <.0001). In contrast, exercise-induced ventricular ectopy beyond single PVCs was far more common among patients with CPVT (14/16 [88%]; P <.0001) and included PVCs in bigeminy in 13 (81%), couplets in 7 (47%), and nonsustained ventricular tachycardia in 3 (19%). Of note, bidirectional VT was not present in any of the 16 patients diagnosed with CPVT, including the 10 with genetically proven, RYR2-mediated CPVT. CONCLUSION: Exercise-induced ventricular ectopy exceeding single PVCs was observed in less than 10% of patients referred for LQTS evaluation, including 2% of patients ultimately dismissed as normal. Exercise-induced bigeminy is strongly associated with the presence of significant cardiovascular disease but is far more likely to indicate CPVT than LQTS. |
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Authors:
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Justin M Horner; Michael J Ackerman |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2008-09-04 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 5 ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-12-16 Completed Date: 2009-04-07 Revised Date: 2012-02-20 |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 1690-4 Citation Subset: IM |
Affiliation:
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Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Diagnosis, Differential Electrocardiography* Exercise Test / adverse effects* Female Follow-Up Studies Heart Rate / physiology Humans Long QT Syndrome / diagnosis*, physiopathology Male Prognosis Retrospective Studies Ventricular Premature Complexes / diagnosis, etiology*, physiopathology Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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HD42569/HD/NICHD NIH HHS; KL2 RR024151-06/RR/NCRR NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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