Background: Atrial fibrillation (AF) is an increasingly common arrhythmia and can be dangerous and symptomatic specially in cardiac disease patients. Ventricular Extrasystoles (VES) during exercise testing and the recovery phase have been associated with adverse prognosis. However, there are a very few studies examining the prevalence of VES during exercise and how it associates with AF diagnosis and rhythm.
Methods: This cross-sectional study include participants from HUNT4. Of 2448 participants who underwent VO2max and echocardiography measurements we included a total of 669 cas-es with available ECG measurements, categorized in AF and no-AF groups. Prevalence of VES during the exercise test was extracted by manual assessment of ECGs. Not normally distributed data were analyzed with the non-parametric Mann-Whitney U or Chi-Square tests. A 2-sided value of p≤0.05 was considered statistically significant.
Results: There was no significant difference in the distribution of VES per minute between AF patients with and without cardiovascular disease (CVD) comorbidity (p=0.87). Those with AF rhythm had significantly higher VES burden during exercise compared to sinus rhythm (p<0.001). In sinus rhythm the distribution was rather similar between non-AF and AF patients with 40 and 46% having no VES and 10 and 13%, having ≥ 3 VES per minute, while a smaller proportion (21%) experienced no VES in the AF group while 24% had ≥ 3 VES. A significant difference in the distribution of VES between the AF vs. no AF group (p=0.007) and the AF rhythm vs. sinus rhythm (p<0.001) was observed. No significant dif-ference in decreased vs. increased VES from first to last minute between those in CVD and no CVD in both sinus rhythm or AF (p=0.60 and p=0.14) were observed. Those in AF with CVD had a significantly higher prevalence of a decreased number of VES during exercise compared to those in sinus rhythm (p=0.03).
Conclusion: Patients with AF overall had a higher prevalence of VES during exercise than non-AF participants. However, among AF patients in sinus rhythm during exercise, the VES prevalence was not higher than AF rhythm group. The VES burden was not different between AF patients with or without other CVD comorbidity.