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Continuous Monitoring for Ventricular Arrhythmias During Exercise Tests FREE

Elliott Antman, MD; Thomas B. Graboys, MD; Bernard Lown, MD
[+] Author Affiliations

Reprint requests to Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115 (Dr Lown).


JAMA. 1979;241(26):2802-2805. doi:10.1001/jama.1979.03290520026019
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Exercise stress testing is being increasingly used to verify exerciseinduced arrhythmia and to aid in assessing antiarrhythmic drug efficacy. The true prevalence of ventricular arrhythmia during exercise testing is underestimated by means other than continuous monitoring. We compared the yield of ventricular premature beats (VPBs) between a continuous recording system ("trendscription") and intermittent monitoring among 39 patients undergoing a total of 50 consecutive exercise studies. By intermittent monitoring, 22 (44%) of 50 of the exercise tests demonstrated VPBs; with trendscription, 31 (62%) exhibited such arrhythmia. Most striking, however, was a sixfold increase in the disclosure of complex and repetitive forms of VPBs (56 vs nine episodes). Thus, this form of monitoring presents a cost-efficient, on-line method that allows concentration on the patient during exercise as well as clear recording of all arrhythmic events.

(JAMA 241:2802-2805, 1979)

REFERENCES

Sheffield LT, Roitman D:  Stress testing methodology . Prog Cardiovasc Dis 19:33-49, 1976;.
Faris JV, McHenry PL, Morris SN:  Concepts and applications of treadmill exercise testing and the exercise electrocardiograph . Am Heart J 95:102-114, 1978;.
Chaitman BR, Bourassa MG, Wagniart P, et al:  Improved efficiency of treadmill exercise testing using a multiple lead ECG system and basic hemodynamic exercise response . Circulation 57:71-79, 1978;.
Fortuin NJ, Weiss JC:  Exercise stress testing . Circulation 56:699-712, 1977;.
Jelinek MV, Lown B:  Exercise stress testing for exposure of cardiac arrhythmia . Prog Cardiovasc Dis 16:497-522, 1974;.
Lown B, Graboys TB:  Management of patients with malignant ventricular arrhythmias . Am J Cardiol 39:910-918, 1977;.
Ryan M, Lown B, Horn H:  Comparison of ventricular ectopic activity during 24-hour monitoring and exercise testing in patients with coronary heart disease . N Engl J Med 292:224-229, 1975;.
Udall JA, Ellestad MH:  Predictive implications of ventricular premature contractions associated with treadmill stress testing . Circulation 56:985-989, 1977;.
Gaughan CE, Lown B, Lanigan J, et al:  Acute oral testing for determining antiarrhythmic drug efficacy: I. Quinidine . Am J Cardiol 38:677-684, 1976;.
Lown B, Matta RJ, Besser HW:  Programmed "trendscription": A new approach to electrocardiographic monitoring . JAMA 232:39-43, 1975;.
Graboys TB, DeSilva RD, Lown B:  Ambulatory monitoring and exercise stress testing in the management of patients with malignant ventricular arrhythmia , abstracted. Am J Cardiol 41:400, 1978;.
Ruberman W, Weinblatt E, Goldberg JE, et al:  Ventricular premature beats and mortality after myocardial infarction . N Engl J Med 279:750-754, 1977;.
Schulze R, Strauss HW, Pitt B:  Sudden death in the year following myocardial infarction: Relation to ventricular premature contractions in the late hospital phase and left ventricular ejection fraction . Am J Med 62:192-199, 1977;.
Moss AJ, DeCamilla JJ, Davis HP, et al:  Clinical significance of ventricular ectopic beats in the early post-hospital phase of myocardial infarction . Am J Cardiol 39:635-639, 1977;.
Bigger JT, Dresdale RJ, Heissenbuttel RH, et al:  Ventricular arrhythmias in ischemic heart disease: Mechanism, prevalence, significance and management . Prog Cardiovasc Dis 19:255-300, 1977;.
Lown B, Graboys TB:  Sudden death: An ancient problem newly perceived . Cardiovasc Med 2:219-233, 1977;.

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Sheffield LT, Roitman D:  Stress testing methodology . Prog Cardiovasc Dis 19:33-49, 1976;.
Faris JV, McHenry PL, Morris SN:  Concepts and applications of treadmill exercise testing and the exercise electrocardiograph . Am Heart J 95:102-114, 1978;.
Chaitman BR, Bourassa MG, Wagniart P, et al:  Improved efficiency of treadmill exercise testing using a multiple lead ECG system and basic hemodynamic exercise response . Circulation 57:71-79, 1978;.
Fortuin NJ, Weiss JC:  Exercise stress testing . Circulation 56:699-712, 1977;.
Jelinek MV, Lown B:  Exercise stress testing for exposure of cardiac arrhythmia . Prog Cardiovasc Dis 16:497-522, 1974;.
Lown B, Graboys TB:  Management of patients with malignant ventricular arrhythmias . Am J Cardiol 39:910-918, 1977;.
Ryan M, Lown B, Horn H:  Comparison of ventricular ectopic activity during 24-hour monitoring and exercise testing in patients with coronary heart disease . N Engl J Med 292:224-229, 1975;.
Udall JA, Ellestad MH:  Predictive implications of ventricular premature contractions associated with treadmill stress testing . Circulation 56:985-989, 1977;.
Gaughan CE, Lown B, Lanigan J, et al:  Acute oral testing for determining antiarrhythmic drug efficacy: I. Quinidine . Am J Cardiol 38:677-684, 1976;.
Lown B, Matta RJ, Besser HW:  Programmed "trendscription": A new approach to electrocardiographic monitoring . JAMA 232:39-43, 1975;.
Graboys TB, DeSilva RD, Lown B:  Ambulatory monitoring and exercise stress testing in the management of patients with malignant ventricular arrhythmia , abstracted. Am J Cardiol 41:400, 1978;.
Ruberman W, Weinblatt E, Goldberg JE, et al:  Ventricular premature beats and mortality after myocardial infarction . N Engl J Med 279:750-754, 1977;.
Schulze R, Strauss HW, Pitt B:  Sudden death in the year following myocardial infarction: Relation to ventricular premature contractions in the late hospital phase and left ventricular ejection fraction . Am J Med 62:192-199, 1977;.
Moss AJ, DeCamilla JJ, Davis HP, et al:  Clinical significance of ventricular ectopic beats in the early post-hospital phase of myocardial infarction . Am J Cardiol 39:635-639, 1977;.
Bigger JT, Dresdale RJ, Heissenbuttel RH, et al:  Ventricular arrhythmias in ischemic heart disease: Mechanism, prevalence, significance and management . Prog Cardiovasc Dis 19:255-300, 1977;.
Lown B, Graboys TB:  Sudden death: An ancient problem newly perceived . Cardiovasc Med 2:219-233, 1977;.
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