1. Home>
2. Specialties>
3. Emergency Medicine>
4. Summary and Comment

Ectopy After Exercise Predicts Increased Risk for Death

Frequent ventricular ectopy during the recovery phase of exercise testing portends a poor prognosis, whereas ectopy during exercise does not.

The prognostic value of exercise testing is related to exercise capacity, which is linked to left ventricular (LV) function. Often, however, exercise testing is used to determine susceptibility to sudden death from coronary occlusion in patients with good LV function. Noting that delayed restoration of parasympathetic tone after exercise testing, as manifested by persistent tachycardia, predicts an increased risk for death, these authors hypothesized that ventricular ectopy during recovery might be a similar marker.

In this study, 29,244 patients who were referred for exercise testing were followed for a mean of 5.3 years; 1862 (6.4%) patients died. Frequent ventricular ectopy occurred in 3% of patients during the exercise phase only, in 2% during the recovery phase only, and in 2% during both phases. The risk for death was increased (adjusted hazard ratio, 1.6) in patients with ectopy during recovery, but not in those with ectopy only during exercise. In patients in whom LV function was measured, ectopy during recovery was associated with a decreased ejection fraction (defined as <40%) and predicted an increased risk for death in patients with decreased EFs (HR, 1.8) or normal EFs (HR, 2.0).

Comment: This study shows the value of routine exercise testing not only for determining prognosis but also for risk stratification, which allows for aggressive management of risk factors. Patients with frequent ventricular ectopy during the recovery phase of exercise testing should be referred for echocardiography.

— J. Stephen Bohan, MS, MD, FACP, FACEP

Published in Journal Watch Emergency Medicine April 15, 2003

Citation(s):

Frolkis JP et al. Frequent ventricular ectopy after exercise as a predictor of death. N Engl J Med 2003 Feb 27; 348:781-90.

• Original article (Subscription may be required)
• Medline abstract (Free)