| Abstract: | ![]()
A series of 131 patients aged from 4 to 70 years old with significant ventricular arrhythmias corresponding to at least Grade 2 of Lown's classification underwent exercise stress testing and continuous 24 hour electrocardiography. There were two objectives: to compare exercise electrocardiography and Holter monitoring in the detection and assessment of the seriousness of the arrhythmia, and to assess the arrhythmia's modifications on exercise. The patients were divided into 4 types: "chronic coronary insufficiency", "mitral valve prolapse", "other cardiac disease" and "idiopathic" arrhythmias. The maximum grade of arrhythmia corresponded to salvos of ventricular extrasystoles in 44 cases (33,5 p. 100), doublets in 44 cases (33,5 p. 100), polymorphic extrasystoles in 10 cases (7,6 p. 100) and monomorphic extrasystoles in 33 cases (25,2 p. 100). A significant arrhythmia was found in 90,8 p. 100 of cases by Holter and in 82,4 p. 100 of cases on exercise stress testing. The maximum grade of arrhythmia was also better appreciated on Holter monitoring (84,7 p. 100) compared to exercise stress testing (46,5 p. 100). The difference being more clear cut for repetitive forms. The superiority of Holter monitoring for assessing the grade of arrhythmia was obvious in the "idiopathic", "other cardiac disease" and "coronary" groups (79,4 p. 100 compared to 41,2 p. 100) but was not significant in the mitral valve prolapse group (73,9 p. 100 compared to 65,2 p. 100). Aggravation of the arrhythmia on exercise defined as a large increase, even transient of the number of extrasystoles (7 cases) or changing to a higher grade (59 cases) was significantly less common (p less than 0,01) in the idiopathic group (30 p. 100) than in the other groups (64,1 p. 100 in the coronary, 65,2 p. 100 in the mitral valve prolapse group). Aggravation of the arrhythmia in the coronary group was not observed more often in positive than in negative exercise electrocardiography. Complete regression of extrasystoles in the last two minutes was observed in 50 cases and significantly more often in idiopathic arrhythmias (p less than 0,01). There was no correlation between the behavior of the arrhythmia on exercise and the presence of salvos of extrasystoles, previous syncope or electrical cardioversion. Important individual differences were observed in all groups of patients. These observations suggest that the statistical superiority of Holter monitoring is debatable and imply that it is often necessary to request both investigations for the exact diagnosis of the arrhythmia and for the eventual therapeutic management of the patient and his mode of life. |
