Stress Test-Induced Ventricular Arrhythmias tied to increased rtality Ris: Study
Researchers have identified in a new study published in BMJ Open Heart journal that ventricular arrhythmias during stress testing as strongly correlated with a subsequent risk of mortality. While atrial arrhythmias found during stress testing are associated with increased future occurrence of atrial fibrillation (AF), coronary artery disease (CAD), or myocardial infarction (MI). The study was conducted by Paul Y Lee and fellow researchers.
A wide search was performed in PubMed, Embase, and Cochrane databases for studies that evaluated arrhythmias under stress testing from all publications up to June 14, 2023. The major interest was in determining mortality risk in patients with ventricular and atrial arrhythmias and the relationship between atrial arrhythmias and future cardiac disease diagnosis. Subgroup analyses were included to distinguish the effect of these arrhythmias in asymptomatic patients.
Key Findings
Ventricular Arrhythmias and Mortality: Patients who had ventricular arrhythmias on stress testing had more than twice the risk of mortality than those without arrhythmias (OR: 2.11, 95% CI: 1.75–2.54, p<0.00001).
Asymptomatic Individuals at Risk: Even in healthy, asymptomatic patients, ventricular arrhythmias were still strongly linked with elevated mortality risk (OR: 2.22, 95% CI: 1.45–3.41, p=0.0003).
Frequent vs. Infrequent PVCs: Those with a high frequency of premature ventricular complexes (PVCs) had an increased risk of death compared to individuals with low PVC frequency (OR: 1.85, 95% CI: 1.27–2.69, p=0.001).
Atrial Arrhythmias and Mortality: An atrial fibrillation (AF) during the stress test revealed no significant relation with mortality (OR: 1.53, 95% CI: 0.05–50.19, p=0.81).
Atrial Arrhythmias and Subsequent AF Diagnosis: Individuals who exhibited atrial arrhythmias during stress testing had a significantly greater likelihood of subsequently being diagnosed with AF (OR: 4.60, 95% CI: 1.59–13.26, p=0.005).
Atrial Arrhythmias and Future Cardiac Disease: Presence of atrial arrhythmias during stress testing was linked to future coronary artery disease or myocardial infarction risk (OR: 1.82, 95% CI: 1.09–3.03, p=0.02).
Ventricular arrhythmias in even asymptomatic patients reflect an enormous risk of mortality and imply that they would be best served by increased monitoring and more intense cardiovascular risk reduction. Conversely, although atrial arrhythmias are not found to affect mortality, their occurrence can act as an early indicator of subsequent AF, CAD, or MI.
These results highlight the significance of arrhythmias induced by stress testing as possible markers of long-term cardiovascular risk, deserving of increased clinical scrutiny and aggressive management approaches.
Reference:
Paul Y Lee, Juan Bello, Sarthak Patel, Rafael Toro-Manotas, Angelo Biviano, Elaine Wan, Hasan Garan, Jose Dizon, Matthew Yuyun, Hirad Yarmohammadi - Prognostic implications of stress test-induced arrhythmias: a systematic review and meta-analysis: Open Heart 2025;12:e003133.
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