Does 24-hour ambulatory monitoring improve the detection of ventricular ectopic activity compared to maximal exercise testing in patients with coronary heart disease?
24-hour ambulatory monitoring is more sensitive than maximal exercise testing for detecting ventricular ectopic activity and complex arrhythmias in patients with coronary heart disease, though the two methods may yield complementary electrophysiologic information.
The exposure of ventricular ectopic activity (VEA) by maximal exercise testing and 24-hour ambulatory monitoring was compared in 100 unselected patients with coronary heart disease. The arrhythmia was noted with exercise in 56 patients and with monitoring in 88. Repetitive forms such as couplets and ventricular tachycardia were found to be twice as frequent (40 vs. 20) with monitoring than with exercise. Patients with prior myocardial infarction had more frequent ventricular ectopic activity of a more advanced grade with both exercise and monitoring than patients with angina pectoris. Exercise exposed the grades of ectopic activity that recurred during two or more hours of the monitoring session. Of seven patients with ventricular tachycardia on exercise only four exhibited this grade with monitoring. It may be that these two methods divulge different information regarding the electrophysiologic state of the myocardium.
Ryan et al. (1975) studied this question.
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