Exercise thallium testing in ventricular preexcitation

Stephen Archer, Charles Gornick, Frank Grund, Rex Shafer, E. Kenneth Weir

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Ventricular preexcitation, as seen in Wolff-Parkinson-White syndrome, results in a high frequency of positive exercise electrocardiographic responses. Why this occurs is unknown but is not believed to reflect myocardial ischemia. Exercise thallium testing is often used for noninvasive assessment of coronary artery disease in patients with conditions known to result in false-positive electrocardiographic responses. To assess the effects of ventricular preexcitation on exercise thallium testing, 8 men (aged 42 ± 4 years) with this finding were studied. No subject had signs or symptoms of coronary artery disease. Subjects exercised on a bicycle ergometer to a double product of 26,000 ± 2,000 (± standard error of mean). All but one of the subjects had at least 1 mm of ST-segment depression. Tests were terminated because of fatigue or dyspnea and no patient had chest pain. Thallium test results were abnormal in 5 patients, 2 of whom had stress defects as well as abnormally delayed thallium washout. One of these subjects had normal coronary arteries on angiography with a negative ergonovine challenge, and both had normal exercise radionuclide ventriculographic studies. Delayed thallium washout was noted in 3 of the subjects with ventricular preexcitation and normal stress images. This study suggests that exercise thallium testing is frequently abnormal in subjects with ventricular preexcitation. Ventricular preexcitation may cause dys-synergy of ventricular activation, which could alter myocardial thallium handling, much as occurs with left bundle branch block. Exercise radionuclide ventriculography may be a better test for noninvasive assessment of coronary artery disease in patients with ventricular preexcitation.

Original languageEnglish (US)
Pages (from-to)1103-1106
Number of pages4
JournalThe American Journal of Cardiology
Issue number12
StatePublished - May 1 1987

Bibliographical note

Funding Information:
From the Veterans Administration Medical Center, Minneapolis, Minnesota. This study was support by an American College of Chest Physicians Fellowship, Park Ridge, Illinois, and the Veterans Administration, 54th Street and 48th Avenue South, Minneapolis, Minnesota. Manuscript received October 14,1986; revised manuscript received and accepted December 29, 1986.


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