Heart Rate Recovery after Exercise Is Associated with Arrhythmic Events in Patients with Catecholaminergic Polymorphic Ventricular Tachycardia

Krystien V.V. Lieve, Veronica Dusi, Christian Van Der Werf, J. Martijn Bos, Conor M. Lane, Mathis Korseberg Stokke, Thomas M. Roston, Aurora Djupsjöbacka, Yuko Wada, Isabelle Denjoy, Henning Bundgaard, Ferran Roses I. Noguer, Christopher Semsarian, Tomas Robyns, Nynke Hofman, Michael W. Tanck, Maarten P. Van Den Berg, Janneke A.E. Kammeraad, Andrew D. Krahn, Sally Ann B. ClurFrederic Sacher, Jan Till, Jonathan R. Skinner, Jacob Tfelt-Hansen, Vincent Probst, Antoine Leenhardt, Minoru Horie, Heikki Swan, Jason D. Roberts, Shubhayan Sanatani, Kristina H. Haugaa, Peter J. Schwartz, Michael J. Ackerman, Arthur A.M. Wilde

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Risk stratification in catecholaminergic polymorphic ventricular tachycardia remains ill defined. Heart rate recovery (HRR) immediately after exercise is regulated by autonomic reflexes, particularly vagal tone, and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Our objective was to evaluate whether HRR after maximal exercise on the exercise stress test (EST) is associated with symptoms and ventricular arrhythmias. Methods: In this retrospective observational study, we included patients ≤65 years of age with an EST without antiarrhythmic drugs who attained at least 80% of their age- A nd sex-predicted maximal HR. HRR in the recovery phase was calculated as the difference in heart rate (HR) at maximal exercise and at 1 minute in the recovery phase (ΔHRR1′). Results: We included 187 patients (median age, 36 years; 68 [36%] symptomatic before diagnosis). Pre-EST HR and maximal HR were equal among symptomatic and asymptomatic patients. Patients who were symptomatic before diagnosis had a greater ΔHRR1′ after maximal exercise (43 [interquartile range, 25-58] versus 25 [interquartile range, 19-34] beats/min; P<0.001). Corrected for age, sex, and relatedness, patients in the upper tertile for ΔHRR1′ had an odds ratio of 3.4 (95% CI, 1.6-7.4) of being symptomatic before diagnosis (P<0.001). In addition, ΔHRR1′ was higher in patients with complex ventricular arrhythmias at EST off antiarrhythmic drugs (33 [interquartile range, 22-48] versus 27 [interquartile range, 20-36] beats/min; P=0.01). After diagnosis, patients with a ΔHRR1′ in the upper tertile of its distribution had significantly more arrhythmic events as compared with patients in the other tertiles (P=0.045). Conclusions: Catecholaminergic polymorphic ventricular tachycardia patients with a larger HRR following exercise are more likely to be symptomatic and have complex ventricular arrhythmias during the first EST off antiarrhythmic drug.

Original languageEnglish (US)
Article numbere007471
JournalCirculation: Arrhythmia and Electrophysiology
StateAccepted/In press - 2020


  • autonomic nervous system
  • death, sudden
  • exercise test
  • heart rate
  • humans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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