Exercise-induced ventricular arrhythmias: analysis of predictive factors in a population with sleep disorders.

Fatima Dumas Cintra,Camila Furtado Rizzi,Dalva Poyares,Wercules Antônio Alves De Oliveira,Marcia Regina Pinho Makdisse,Sergio Tufik,Francisco Otávio De Oliveira Luiz,Angelo Amato Vincenzo De Paola

doi:10.1590/s1679-45082010ao1469

Abstract

To assess the prevalence of ventricular arrhythmias induced by exercise in a population with sleep disorders and to analyze the triggering factors. Patients were consecutively selected from the database of the Sleep Clinic of Universidade Federal de São Paulo. All subjects were submitted to basal polysomnography, blood sample collection, physical examination, 12-lead ECG, spirometry, cardiorespiratory exercise study on a treadmill, and echocardiogram. The Control Group was matched for age and gender. A total of 312 patients were analyzed. Exercise-induced ventricular arrhythmia was observed in 7%. The aortic diameter was larger (3.44 ± 0.30, 3.16 ± 0.36, p = 0.04) and the minimal saturation was lower (92.75 ± 3.05, 95.50 ± 1.73, p=0.01) in the ventricular arrhythmia group when compared to controls, respectively. After correction of the aortic root to body surface, there was only a trend to a larger diameter being associated with the emergence of arrhythmia. Exercise-induced ventricular arrhythmia was observed in 7% of sample and it was associated with lower oxygen saturation during exercise.

Highlights

The physiological changes occurring with exercise may precipitate exercise-induced ventricular arrhythmias (EIVA)(1)
The percentage of sleep time with arterial oxygen saturation lower than 90% was related to the occurrence of complex ventricular ectopy, and those in the categories with higher hypoxia presented a higher risk of this type of arrhythmia (OR = 1.62; 95%CI = 1.23-2.14)
After voluntary interruption of breathing for a mean period of 281 ± 73 seconds, there was a significant drop in oxygen saturation and heart rate and the emergence of cardiac arrhythmias in 77% of the participants, which were directly related to duration of apnea

Summary

Introduction

The physiological changes occurring with exercise may precipitate exercise-induced ventricular arrhythmias (EIVA)(1). Individuals with coronary artery disease who develop ventricular arrhythmia during exercise present worse prognosis[3,4]. The occurrence of this type of arrhythmia in individuals without structural cardiac disease presents conflicting results in the medical literature[5,6]. Changes in the amount and quality of sleep are being associated with higher cardiovascular mortality rates[7]. Obstructive sleep apnea (OSA) is related to the emergence of heart failure[8,9], cardiac arrhythmias[10], metabolic syndrome[11], dyslipidemia[12] and even cerebrovascular accident[13]. Few hours of sleep is related to higher cardiovascular mortality[15]

Methods

Results

Conclusion