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ECG changes during exercise stress testing, such as false-positive ST-segment depression and disappearance of the delta wave, are reported in patients with the Wolff-Parkinson-White (WPW) pattern. We present a case of exercise testing in a 53-year-old man with WPW syndrome with ischemic-appearing ECG changes and normal nuclear stress perfusion study findings who was thought to be at clinically low risk for having significant coronary disease. A literature review is discussed. Although ST-segment depression typical for ischemia occurs in half of the patients in whom WPW syndrome is reported, exercise testing is still an important tool in their evaluation. Data other than ECG response can be interpreted in the context of clinical history and physical examination findings to stratify the risk of coronary disease. Complete and sudden disappearance of the delta wave has been seen during exercise in 20% of patients with WPW syndrome and can identify those who are at low risk for sudden arrhythmic death.
(CHEST 2005; 127:1454-1457)
Key words: exercise test; preexcitation syndromes; Wolff-Parkinson-White syndrome
Abbreviations: EP = electrophysiology; WPW = Wolff-Parkinson-White
ECG changes during exercise testing, including ST-segment depression and loss of the delta wave, occur in patients with Wolff-Parkinson-White (WPW) syndrome.1,2 Since Lamb3 first reported a case of a false-positive exercise test result in 1959, knowledge of ECG changes in the setting of WPW syndrome has been limited to several studies with small numbers of patients. The following case illustrates typical false-positive ECG changes and the disappearance of the delta wave that are elicited during treadmill testing in a patient with WPW syndrome. We review the literature to determine the frequency and clinical implications of these ECG changes, and discuss clinical situations in which exercise testing may be of value.
CASE REPORT
A 53-year-old man was sent for exercise testing prior to rotator cuff surgery. He was noted to have the WPW pattern on the ECG during his preoperative evaluation. The patient complained of occasional mild, atypical, nonpredictable chest discomfort. His medical history was unremarkable with no risk factors for coronary artery disease. On physical examination, he was normotensive with unremarkable cardiovascular examination findings. His baseline heart rate was 60 beats/min, and his baseline BP was 118/68 mm Hg. He exercised for 12 min and 24 s, reaching 13 metabolic...