Treadmill exercise testing in the Wolff-Parkinson-White syndrome
Identifieur interne : 000179 ( Main/Corpus ); précédent : 000178; suivant : 000180Treadmill exercise testing in the Wolff-Parkinson-White syndrome
Auteurs : Boris Strasberg ; William W. Ashley ; Christopher R. C. Wyndham ; Robert A. Bauernfeind ; Steven P. Swiryn ; Ramesh C. Dhingra ; Kenneth M. RosenSource :
- The American Journal of Cardiology [ 0002-9149 ] ; 1979.
Abstract
Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.
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DOI: 10.1016/0002-9149(80)90116-2
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Ashley</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Wyndham, Christopher R C" sort="Wyndham, Christopher R C" uniqKey="Wyndham C" first="Christopher R. C." last="Wyndham">Christopher R. C. Wyndham</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Bauernfeind, Robert A" sort="Bauernfeind, Robert A" uniqKey="Bauernfeind R" first="Robert A." last="Bauernfeind">Robert A. 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Rosen</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4</idno><date when="1980" year="1980">1980</date><idno type="doi">10.1016/0002-9149(80)90116-2</idno><idno type="url">https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000179</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title><author><name sortKey="Strasberg, Boris" sort="Strasberg, Boris" uniqKey="Strasberg B" first="Boris" last="Strasberg">Boris Strasberg</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Ashley, William W" sort="Ashley, William W" uniqKey="Ashley W" first="William W." last="Ashley">William W. Ashley</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Wyndham, Christopher R C" sort="Wyndham, Christopher R C" uniqKey="Wyndham C" first="Christopher R. C." last="Wyndham">Christopher R. C. Wyndham</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Bauernfeind, Robert A" sort="Bauernfeind, Robert A" uniqKey="Bauernfeind R" first="Robert A." last="Bauernfeind">Robert A. Bauernfeind</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Swiryn, Steven P" sort="Swiryn, Steven P" uniqKey="Swiryn S" first="Steven P." last="Swiryn">Steven P. Swiryn</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Dhingra, Ramesh C" sort="Dhingra, Ramesh C" uniqKey="Dhingra R" first="Ramesh C." last="Dhingra">Ramesh C. Dhingra</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author><author><name sortKey="Rosen, Kenneth M" sort="Rosen, Kenneth M" uniqKey="Rosen K" first="Kenneth M." last="Rosen">Kenneth M. Rosen</name><affiliation><mods:affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="ISSN">0002-9149</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1979">1979</date><biblScope unit="volume">45</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="742">742</biblScope><biblScope unit="page" to="748">748</biblScope></imprint><idno type="ISSN">0002-9149</idno></series><idno type="istex">3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4</idno><idno type="DOI">10.1016/0002-9149(80)90116-2</idno><idno type="PII">0002-9149(80)90116-2</idno><idno type="ArticleID">80901162</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Boris Strasberg MD</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>William W. Ashley MD</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>Christopher R.C. Wyndham MD, FACC</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>Robert A. Bauernfeind MD</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>Steven P. Swiryn MD</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>Ramesh C. Dhingra MD, FACC</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item><json:item><name>Kenneth M. Rosen MD, FACC</name><affiliations><json:string>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</json:string></affiliations></json:item></author><articleId><json:string>80901162</json:string></articleId><language><json:string>eng</json:string></language><abstract>Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.</abstract><qualityIndicators><score>6.87</score><pdfVersion>1.2</pdfVersion><pdfPageSize>612 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1901</abstractCharCount><pdfWordCount>3870</pdfWordCount><pdfCharCount>27303</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>259</abstractWordCount></qualityIndicators><title>Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title><pii><json:string>0002-9149(80)90116-2</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>45</volume><pii><json:string>S0002-9149(00)X0470-5</json:string></pii><pages><last>748</last><first>742</first></pages><issn><json:string>0002-9149</json:string></issn><issue>4</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>The American Journal of Cardiology</title><publicationDate>1980</publicationDate></host><publicationDate>1979</publicationDate><copyrightDate>1980</copyrightDate><doi><json:string>10.1016/0002-9149(80)90116-2</json:string></doi><id>3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1980</date></publicationStmt><notesStmt><note>This work was supported in part by training grant HL 07387 and research grants HL 18794 and HL 23566 from the National Heart, Lung, and Blood Institute, the National Institutes of Health, Bethesda, Maryland.</note><note type="content">Section title: Clinical study</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Boris</forename><surname>Strasberg</surname></persName><roleName type="degree">MD</roleName><note type="biography">Address for reprints: Boris Strasberg, MD, Cardiology Section, University of Illinois Hospital, P.O. Box 6998, Chicago, Illinois 60680.</note><affiliation>Address for reprints: Boris Strasberg, MD, Cardiology Section, University of Illinois Hospital, P.O. Box 6998, Chicago, Illinois 60680.</affiliation><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">William W.</forename><surname>Ashley</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">Christopher R.C.</forename><surname>Wyndham</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">Robert A.</forename><surname>Bauernfeind</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">Steven P.</forename><surname>Swiryn</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">Ramesh C.</forename><surname>Dhingra</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author><author><persName><forename type="first">Kenneth M.</forename><surname>Rosen</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation></author></analytic><monogr><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="pISSN">0002-9149</idno><idno type="PII">S0002-9149(00)X0470-5</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1979"></date><biblScope unit="volume">45</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="742">742</biblScope><biblScope unit="page" to="748">748</biblScope></imprint></monogr><idno type="istex">3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4</idno><idno type="DOI">10.1016/0002-9149(80)90116-2</idno><idno type="PII">0002-9149(80)90116-2</idno><idno type="ArticleID">80901162</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1980</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.</p></abstract></profileDesc><revisionDesc><change when="1979-11-11">Registration</change><change when="1979">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>AJC</jid><aid>80901162</aid><ce:pii>0002-9149(80)90116-2</ce:pii><ce:doi>10.1016/0002-9149(80)90116-2</ce:doi><ce:copyright type="unknown" year="1980"></ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>This work was supported in part by training grant HL 07387 and research grants HL 18794 and HL 23566 from the National Heart, Lung, and Blood Institute, the National Institutes of Health, Bethesda, Maryland.</ce:note-para></ce:article-footnote><ce:dochead><ce:textfn>Clinical study</ce:textfn></ce:dochead><ce:title>Treadmill exercise testing in the Wolff-Parkinson-White syndrome</ce:title><ce:author-group><ce:author><ce:given-name>Boris</ce:given-name><ce:surname>Strasberg</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="COR1"><ce:sup loc="post">∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>William W.</ce:given-name><ce:surname>Ashley</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Christopher R.C.</ce:given-name><ce:surname>Wyndham</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>Robert A.</ce:given-name><ce:surname>Bauernfeind</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Steven P.</ce:given-name><ce:surname>Swiryn</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Ramesh C.</ce:given-name><ce:surname>Dhingra</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>Kenneth M.</ce:given-name><ce:surname>Rosen</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:affiliation><ce:textfn>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for reprints: Boris Strasberg, MD, Cardiology Section, University of Illinois Hospital, P.O. Box 6998, Chicago, Illinois 60680.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="17" month="10" year="1979"></ce:date-received><ce:date-accepted day="11" month="11" year="1979"></ce:date-accepted><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010">Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.</ce:simple-para><ce:simple-para view="all" id="simple-para.0015">Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Treadmill exercise testing in the Wolff-Parkinson-White syndrome</title></titleInfo><name type="personal"><namePart type="given">Boris</namePart><namePart type="family">Strasberg</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><description>Address for reprints: Boris Strasberg, MD, Cardiology Section, University of Illinois Hospital, P.O. Box 6998, Chicago, Illinois 60680.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">William W.</namePart><namePart type="family">Ashley</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Christopher R.C.</namePart><namePart type="family">Wyndham</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert A.</namePart><namePart type="family">Bauernfeind</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Steven P.</namePart><namePart type="family">Swiryn</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ramesh C.</namePart><namePart type="family">Dhingra</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kenneth M.</namePart><namePart type="family">Rosen</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Cardiology Section, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, University of Illinois Hospital, Chicago, Illinois USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1979</dateIssued><dateValid encoding="w3cdtf">1979-11-11</dateValid><copyrightDate encoding="w3cdtf">1980</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Graded treadmill exercise testing was performed in 54 patients with the Wolff-Parkinson-White syndrome and preexcitation (persistent in 36, intermittent in 9 and concealed in 9). Forty-eight patients had previous paroxysmal supraventricular arrhythmia (spontaneous or induced or both). At initiation of treadmill testing, the nine patients with intermittent and the nine with concealed preexcitation had normal conduction. None manifested preexcitation during exercise. Thirty-six patients had preexcitation at initiation of exercise; exercise produced no change in preexcitation in 2, partial normalization of the QRS complex in 16 (due to enhanced atrioventricular [A-V] nodal conduction), and total normalization of the QRS complex in 18 (due to enhanced A-V nodal conduction in 14 and to rate-dependent anomalous pathway block in 4). Exercise-provoked block of the anomalous pathway reflected prolonged anomalous pathway refractoriness, as measured with atrial stimulation. All 18 patients with either total or partial preexcitation at peak exercise manifested more than 1 mm flat or downsloping S-T segment depression. None had evidence of ischemic heart disease. None of the 54 patients manifested either paroxysmal supraventricular tachycardia or atrial fibrillation during or after treadmill exercise.Treadmill exercise testing in patients with preexcitation frequently produces partial or total normalization of the QRS complex due to enhanced A-V nodal conduction and, less commonly, total normalization due to rate-dependent block of the anomalous pathway. False positive S-T segment changes (suggesting ischemia) are always present in patients manifesting preexcitation during treadmill testing. Treadmill exercise testing in patients with preexcitation does not provoke paroxysmal supraventricular tachycardia or atrial fibrillation and is not useful as a provocative test for arrhythmia.</abstract><note>This work was supported in part by training grant HL 07387 and research grants HL 18794 and HL 23566 from the National Heart, Lung, and Blood Institute, the National Institutes of Health, Bethesda, Maryland.</note><note type="content">Section title: Clinical study</note><relatedItem type="host"><titleInfo><title>The American Journal of Cardiology</title></titleInfo><titleInfo type="abbreviated"><title>AJC</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">198004</dateIssued></originInfo><identifier type="ISSN">0002-9149</identifier><identifier type="PII">S0002-9149(00)X0470-5</identifier><part><date>198004</date><detail type="volume"><number>45</number><caption>vol.</caption></detail><detail type="issue"><number>4</number><caption>no.</caption></detail><extent unit="issue pages"><start>A111</start><end>A124</end></extent><extent unit="issue pages"><start>A125</start><end>A136</end></extent><extent unit="issue pages"><start>A137</start><end>A150</end></extent><extent unit="issue pages"><start>A4</start><end>A52</end></extent><extent unit="issue pages"><start>A53</start><end>A64</end></extent><extent unit="issue pages"><start>A65</start><end>A76</end></extent><extent unit="issue pages"><start>A79</start><end>A94</end></extent><extent unit="issue pages"><start>A95</start><end>A110</end></extent><extent unit="issue pages"><start>725</start><end>922</end></extent><extent unit="pages"><start>742</start><end>748</end></extent></part></relatedItem><identifier type="istex">3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4</identifier><identifier type="DOI">10.1016/0002-9149(80)90116-2</identifier><identifier type="PII">0002-9149(80)90116-2</identifier><identifier type="ArticleID">80901162</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments><istex:refBibTEI uri="https://api.istex.fr/document/3A14295D720A6A8C7EB3082A9736B4EDBB91ADE4/enrichments/refBib"><teiHeader></teiHeader><text><front></front><body></body><back><listBibl><biblStruct><monogr></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Syndrome of short PR interval with abnormal QRS complexes and paroxysmal tachycardia</title><author><persName><forename type="first">References</forename><forename type="middle">L</forename><surname>Wolff</surname></persName></author><author><persName><surname>White</surname></persName></author></analytic><monogr><title level="j">Arch Intern Med</title><imprint><biblScope unit="volume">82</biblScope><biblScope unit="page" from="446" to="67"></biblScope><date type="published" when="1948"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Electrocardiographic findings in 67,375 asymptomatic subjects. 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