Cardiac arrhythmias triggered by sudden and dynamic efforts.

BACKGROUND: Some arrhythmias are triggered only during exercise. The aim of this study is to describe the frequency and type of arrhythmia induced by a standardized protocol of sudden and dynamic exercise, which tends to reflect routine situations of efforts (e.g., climbing stairs), and compare with those found on maximal cardiopulmonary exercise test (CPET). METHODS: A total of 2329 subjects (1594 men) aged 9-91 years (mean 52 years, SD +/- 16) were submitted to a standardized protocol of sudden and dynamic exercise (4-second exercise test [4sET]) prior to a CPET. A continuous digital electrocardiogram (ECG) was recorded during 4sET and CPET, and later reviewed and interpreted by the same physician (who supervised all the procedures). RESULTS: A total of 1125 subjects (43%) had cardiac arrhythmias during one or both procedures. About 57% of the arrhythmias were supraventricular, but 47 subjects (2% of all subjects) presented more complex arrhythmias including 43 cases of nonsustained supraventricular tachycardia and four nonsustained ventricular tachycardia. While arrhythmias were more often exposed by the CPET (P < 0.01), in 221 cases (10% of the total sample) of arrhythmias they were only induced by 4sET; these included four cases of nonsustained supraventricular tachycardia. CONCLUSION: 4sET-induced arrhythmias tend to be simple and were always short-lasting. In some cases, ECG recording during 4sET showed arrhythmias that would not be induced by a progressive maximal exercise test. Different situations of exercise, sudden and short versus maximal and progressive, tend to generate different arrhythmic responses and possibly complementary clinical implications.