Burst Exercise Testing Can Unmask Arrhythmias in Patients With Incompletely Penetrant Catecholaminergic Polymorphic Ventricular Tachycardia

JACC Clin Electrophysiol. 2021 Apr;7(4):437-441. doi: 10.1016/j.jacep.2021.02.013.

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is characterized by cardiac arrest during sudden exertion. However, standard exercise stress testing (EST) lacks sensitivity, leading to misdiagnosis and undertreatment. After a nondiagnostic standard gradual EST, we report 6 patients who underwent a novel burst exercise test characterized by sudden high workload at the outset of testing. In 5 of 6 patients, the burst EST induced new and more complex arrhythmias versus standard EST, which compelled medication initiation in 3 patients. We postulate that this simple EST modification better mimics a typical CPVT triggering event and could improve diagnostic sensitivity and therapeutic decision making.

Keywords: cardiac arrest; catecholaminergic polymorphic ventricular tachycardia; exercise stress test; sudden death; syncope.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Arrhythmias, Cardiac
  • Death, Sudden, Cardiac
  • Electrocardiography
  • Exercise Test*
  • Humans
  • Polymorphic Catecholaminergic Ventricular Tachycardia
  • Tachycardia, Ventricular* / diagnosis