Frequency and characteristics of exercise-induced second-degree atrioventricular block in patients undergoing stress testing

Background: Spontaneous second-degree atrioventricular block induced by exercise (Ex2AVB) is rare, but it can cause profound exercise intolerance. Objective: We sought to determine the frequency of Ex2AVB in our exercise testing practice and to describe characteristics of patients with Ex2AVB. We hypothesized that the number of patients would be small, but they would require invasive treatment. Methods: We reviewed the Mayo Clinic Integrated Stress Center database for nonimaging tests performed from 2006 through 2010. All exercise tests coded as “second-degree atrioventricular block” were captured and reviewed. Tests were excluded if results showed evidence of second-degree atrioventricular block at rest. Results: From 40,715 tests performed, definite Ex2AVB was found in only 19 patients (0.05%; 5 women and 14 men). Ex2AVB occurred as a Mobitz type II block in 4 patients and as a Mobitz type I block in 15. In 3 patients, Ex2AVB occurred only in recovery. Ex2AVB was intermittent in 11 patients and persistent in 8. Mean peak heart rate was higher with intermittent Ex2AVB than with persistent Ex2AVB (126 ± 39 vs 88 ± 28 bpm, P < .01), as was mean functional aerobic capacity (87% ± 20% vs 59% ± 14%, P < .01). Seven patients with persistent Ex2AVB received a permanent pacemaker; 1 underwent pacemaker adjustment. Conclusion: Ex2AVB is uncommon but can cause exercise intolerance that requires pacemaker implantation. Structural or ischemic heart disease and resting conduction abnormalities are common findings in patients with Ex2AVB. Intervention is seldom required for intermittent Ex2AVB.