The authors investigated the prevalence of ventricular ectopic activity (VEA) during exercise testing and 24-hour ambulatory Holter monitoring and its relation with ischemic episodes during daily activities before and during
therapy with
diltiazem and
penbutolol in 41 patients with stable and typical
angina pectoris. Seven (17%) of the 41 patients had exercise-induced ventricular ectopic activity (EIVA). Premature ventricular complexes (
PVC) Lown grade I disappeared in 6 patients on
therapy and appeared in another 6 new patients.
PVC Lown grade IV A in one patient before
therapy changed to Lown grade IV B upon
therapy. There was no difference between patients with and without EIVA in the ages, average number of angina onset per day, percentage patients with exercise angina, average functional class, percentage of patients with exercise ST depression, average maximal ST depression, heart rate and systolic blood pressure at peak exercise and duration of exercise. The workload before
therapy was similar in the 2 groups, but was significantly greater during
therapy in patients without EIVA. During 984 hours of recording, 185 ischemic episodes were detected in 25 patients before
therapy, and 111 ischemic episodes in 20 patients during
therapy.
PVC was observed in 12 (48%) of the 25 patients and in 81 (27%) of the 295 ischemic episodes. VEA during ischemic episodes was observed in patients with and without baseline
PVC. The ventricular arrhythmias found were more complex types during ischemic episodes than baseline. Thus, the incidence of VEA in patients with stable and typical
angina pectoris was 17% during exercise and 52% during daily activities.(ABSTRACT TRUNCATED AT 250 WORDS)