Ventricular arrhythmias of the recovery period after physical exercise: analysis of the problem

Traditionally, stress tests in medicine have been used to diagnose coronary artery disease. However, this article explores their potential far more broadly, demonstrating that these tests can provide crucial information in the evaluation of patients with ventricular arrhythmias. The paper offers a detailed examination of the pathophysiological mechanisms underlying these arrhythmias, identifying autonomic nervous system imbalance as a key factor — specifically, reduced vagal reactivity against a backdrop of persistent elevated sympathetic activity.
The significance of a thorough assessment is emphasized, extending beyond the exercise phase itself to include the recovery period, which is usefully divided into an early phase (up to three minutes) and a late phase (after four minutes). A minute-by-minute analysis of ventricular arrhythmias recorded during post-exercise recovery enables the identification of specific early recovery phase arrhythmias (termed “sympathetic-driven”), which carry an unfavorable prognosis. These arrhythmias prove to be more significant predictors of cardiovascular complications than those occurring solely at peak exercise and often serve as markers of concealed structural heart disease.
The article underscores that the primary objective for the clinician must be the timely identification of the underlying pathology manifesting as these arrhythmias. Differentiated approaches to antiarrhythmic treatment, tailored to the nature of the rhythm disturbances, are also discussed. The early detection of patients with such arrhythmias will help prevent cases of sudden cardiac death, particularly among young individuals engaged in sports. Thus, the presented research highlights the pressing need for further in-depth study and systematization of ventricular arrhythmias during the recovery period to enhance the effectiveness of diagnostics and prevention in cardiovascular disease.

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