Exercise-induced ventricular tachycardia. Clinical features, relation to chronic ventricular ectopy, and prognosis

To determine the clinical status, the occurrence of chronic ambulatory arrhythmias, and the prognosis of patients with exercise-induced ventricular tachycardia, 26 patients with ventricular tachycardia during or immediately following exercise on a treadmill were evaluated. Of the 26 patients, 16 had coronary arterial disease, 2 had nonischemic cardiomyopathy, and 8 had no other cardiac disease. 11 (61%) of the 18 patients with heart disease developed ventricular tachycardia during exercise, in contrast to 6 (75%) of 8 normal subjects who had ventricular tachycardia after exercise. In 8 patients with repeat stress testing, 4 (50%) had reproducible ventricular tachycardia or malignant ventricular ectopic beats. In 19 (73%) of 26 patients, malignant ventricular ectopy occurred on random 24-hr electrocardiographic monitoring; ventricular tachycardia occurred in 5/26 (19%), and malignant ventricular ectopic beats occurred in 14/26 (54%). 15 (83%) of 18 patients with cardiac disease vs 4 (50%) of 8 normal subjects (P<0.05) evidenced malignant ventricular ectopy during ambulatory monitoring. Only one episode of sudden cardiac death occurred in 24 patients followed for 21 mth. Thus, 30% (8) of the patients with exercise-induced ventricular tachycardia had no evidence of heart disease. Furthermore, exercise-provoked ventricular tachycardia presaged sudden death in only one of 24 patients; however, ventricular tachycardia with exercise correctly predicts the presence of chronic advanced ventricular ectopic beats or ventricular tachycardia in 73% (19/26) of the patients.