TY - JOUR
T1 - Heart Rate Recovery after Exercise Is Associated with Arrhythmic Events in Patients with Catecholaminergic Polymorphic Ventricular Tachycardia
AU - Lieve, Krystien V.V.
AU - Dusi, Veronica
AU - Van Der Werf, Christian
AU - Bos, J. Martijn
AU - Lane, Conor M.
AU - Stokke, Mathis Korseberg
AU - Roston, Thomas M.
AU - Djupsjöbacka, Aurora
AU - Wada, Yuko
AU - Denjoy, Isabelle
AU - Bundgaard, Henning
AU - Noguer, Ferran Roses I.
AU - Semsarian, Christopher
AU - Robyns, Tomas
AU - Hofman, Nynke
AU - Tanck, Michael W.
AU - Van Den Berg, Maarten P.
AU - Kammeraad, Janneke A.E.
AU - Krahn, Andrew D.
AU - Clur, Sally Ann B.
AU - Sacher, Frederic
AU - Till, Jan
AU - Skinner, Jonathan R.
AU - Tfelt-Hansen, Jacob
AU - Probst, Vincent
AU - Leenhardt, Antoine
AU - Horie, Minoru
AU - Swan, Heikki
AU - Roberts, Jason D.
AU - Sanatani, Shubhayan
AU - Haugaa, Kristina H.
AU - Schwartz, Peter J.
AU - Ackerman, Michael J.
AU - Wilde, Arthur A.M.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - autonomic nervous system
KW - death, sudden
KW - exercise test
KW - heart rate
KW - humans
UR - http://www.scopus.com/inward/record.url?scp=85082093960&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082093960&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.119.007471
DO - 10.1161/CIRCEP.119.007471
M3 - Article
C2 - 32063070
AN - SCOPUS:85082093960
SN - 1941-3149
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
M1 - e007471
ER -