Ventricular Premature Beats During Exercise Testing: From Autonomic Imbalance to Risk Stratification
U.X.Gayupova , Tashkent State Medical University, Uzbekistan M.E.Rahimova , Tashkent State Medical University, Uzbekistan
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Abstract
This analytical review integrates contemporary publications addressing the assessment of premature ventricular contractions (PVCs) recorded during treadmill testing. The main focus is on distinguishing the prognostic value of arrhythmias occurring during exercise itself from those appearing during the post-exercise recovery phase. Quantitative syntheses published in 2020–2025, based on cohorts totaling more than 30,000 participants, as well as the largest population-based UK Biobank study using machine-learning algorithms for ectopic-beat detection, are reviewed. The evidence indicates that each additional unit of arrhythmic burden is associated with a monotonic increase in the probability of adverse outcomes, with complex rhythms (couplets, triplets, and bigeminy) during the first minutes after cessation of physical activity showing the greatest predictive capacity. The pathophysiological basis of this phenomenon is insufficient reactivation of the parasympathetic nervous system in the setting of persistent adrenergic stimulation. Detection of such abnormalities requires detailed minute-by-minute analysis of the recovery interval and expanded instrumental assessment, including myocardial imaging methods.
Keywords
Premature ventricular contractions, exercise ECG (treadmill test), recovery period
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