🫀 Mirza's Cardiology Notes

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

2 min read

Diagnosis

Exercise ECG

  • Primary method for provoking adrenergically mediated ventricular arrhythmias.1
  • Exercise testing typically provokes premature ventricular contractions, followed by the appearance of couplets and non-sustained polymorphic or bidirectional VT in patients with CPVT. 2

Burst Exercise Testing

  • Unlike the gradual exercise testing that is typically completed, patients undergo a sudden high workload at the outset of testing. Roston’s group “postulate that this simple EST modification better mimics a typical CPVT triggering event and could improve diagnostic sensitivity and therapeutic decision making.”3
  • 1 found that “the Burst protocol was associated with more severe ventricular arrhythmias in 20 of 28 patients (71%) and a higher median arrhythmia score than the Bruce protocol (3 vs 1).”

Footnotes

  1. Naderi B, Li COY, Davies B, Kallas D, Laksman ZWM, Franciosi S, Sanatani S, Krahn AD, Roston TM. Burst Exercise Stress Testing in Catecholaminergic Polymorphic Ventricular Tachycardia. JAMA Cardiol. 2026 Apr 8:e260384. doi: 10.1001/jamacardio.2026.0384. Epub ahead of print. PMID: 41949873; PMCID: PMC13063139. ↩ ↩2

  2. Raymond W. Sy, Andrew D. Krahn, Exercise testing: the catecholaminergic polymorphic ventricular tachycardia crystal ball?, EP Europace, Volume 14, Issue 9, September 2012, Pages 1225–1227, https://doi.org/10.1093/europace/eus146 ↩

  3. Roston TM, Kallas D, Davies B, Franciosi S, De Souza AM, Laksman ZW, Sanatani S, Krahn AD. 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. PMID: 33888264. ↩

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