Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality

Quick Takes

  • In a study of 5,486 asymptomatic individuals who underwent exercise treadmill testing, high-grade premature ventricular contractions (PVCs), defined as either frequent (>10 per minute), multifocal, R-on-T type, or ≥2 PVCs in a row), were associated with cardiovascular mortality (hazard ratio, 1.82; p = 0.006) if they occurred during recovery.
  • High-grade PVCs occurring during the exercise phase were not associated with increased risk.
  • There was no significant difference in the ability of recovery high-grade PVCs to predict cardiovascular mortality among those with and without baseline diabetes, hyperlipidemia, or hypertension, or between men and women.

Study Questions:

Do high-grade premature ventricular contractions (PVCs) during stress testing predict mortality in asymptomatic individuals?


The authors analyzed data from the Lipid Research Clinics prospective cohort, which included 5,486 asymptomatic individuals. Patients underwent treadmill testing. Survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent [>10 per minute], multifocal, R-on-T type, or ≥2 PVCs in a row) with all-cause and cardiovascular mortality.


Mean baseline age was 45 years; 42% were women. During a mean follow-up of 20 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (hazard ratio, 1.82; p = 0.006). High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination.


The authors concluded that high-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.


Prior studies have assessed the prognostic value of PVC timing in individuals suspected or known to have coronary heart disease who were referred for exercise testing. The present study has examined the prognostic value of PVCs in patients with no symptoms. As in the prior studies, the present study showed an increase in risk of cardiovascular mortality if the complex ventricular ectopy occurs in recovery, and no increase in risk if the PVCs occur during exercise. PVCs during exercise result from enhanced catecholaminergic state, while ectopy in recovery suggests insufficient vagal reactivation following exercise. It is unclear why the PVCs occurring during recovery are associated with increased mortality.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Exercise, Hypertension

Keywords: Arrhythmias, Cardiac, Coronary Disease, Cardiac Complexes, Premature, Diabetes Mellitus, Diagnostic Techniques and Procedures, Exercise, Exercise Test, Hyperlipidemias, Hypertension, Lipids, Primary Prevention, Risk Assessment, Ventricular Premature Complexes

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