Key result
Incremental Maximal Exercise Test induced significantly more ventricular and/or supraventricular arrhythmias than submaximal Harvard Step Test in young athletes (8.4% vs 2.6%, p<0.001).
Why the study?
Pre-participation screening identifies cardiac conditions that can cause sudden cardiac death, but the ability of different exercise test intensities and modalities to induce and detect arrhythmias in young athletes needed comparison.
Does incremental Maximal Exercise Test (MET) compared to submaximal Harvard Step Test (HST) increase the detection of arrhythmias in young athletes during pre-participation screening?
Observational (n=1,000)
Does incremental Maximal Exercise Test (MET) compared to submaximal Harvard Step Test (HST) increase the detection of arrhythmias in young athletes during pre-participation screening?
Absolute Event Rate: 8.4% vs 2.6%
p-value: p=< 0.001
Maximal exercise testing on a treadmill induces significantly more arrhythmias than submaximal step testing in young athletes, suggesting it may be a more sensitive modality for pre-participation screening.
HST may detect more arrhythmias than MET during athlete screening; leaves open whether it improves SCD risk stratification or should replace MET.
Pre-participation screening is performed to identify underlying cardiac conditions that may also lead to sudden cardiac death. Our aim is to compare submaximal Harvard Step Test (HST) with incremental Maximal Exercise Test (MET) on treadmill to induce and detect arrhythmias in younger athletes. A total of 1000 athletes (mean age 14.6 ± 4.7 years) were evaluated, 500 with MET and 500 with HST, all with continuous ECG monitoring until three minutes of recovery. Pre-test evaluation includes medical history, clinical evaluation and resting electrocardiogram. Ventricular and/or supraventricular arrhythmias were observed in 2.6% of athletes performing HST and in 8.4% during MET (p < 0.001). Incidence of arrhythmias remained higher for MET also considering separately exercise phase (0.8% vs. 5.2%; p < 0.001) and recovery phase (2.0% vs. 6.0%; p < 0.01). No gender differences were observed. Results suggest that MET induces more arrhythmias than submaximal HST, regardless of test phase. Higher test intensity and longer exercise duration might influence test outcomes, making MET more arrhythmogenic.
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Quinto et al. (2021) conducted an observational in Pre-participation screening in young athletes (n=1,000). Incremental Maximal Exercise Test (MET) vs. Submaximal Harvard Step Test (HST) was evaluated on Ventricular and/or supraventricular arrhythmias (p=< 0.001). Incremental Maximal Exercise Test induced significantly more ventricular and/or supraventricular arrhythmias than submaximal Harvard Step Test in young athletes (8.4% vs 2.6%, p<0.001).
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