Concordance Between Exercise Stress Testing and Electrophysiologic Study for Supraventricular Tachyarrhythmia Induction



Manuchehr F ; Ezabadi S G ; Rahimbakhsh A ; Zourouni A ; Shahrzad S
Source: Iranian Heart Journal Published:2026

Abstract

Background: Supraventricular tachyarrhythmias (SVTs) are common arrhythmias with paroxysmal presentations that often hinder electrocardiographic documentation during symptomatic episodes. Exercise stress testing may provoke SVT through sympathetic stimulation and increased myocardial demand. This study evaluated the concordance between exercise testing and electrophysiologic study (EPS) in patients with EPS-inducible SVT. Methods: This cross-sectional study included 71 patients with confirmed or suspected SVT referred to a tertiary center (April 2020–March 2021). Exclusion criteria were pregnancy, age below 15 years, inability to exercise, refusal, and absence of inducible arrhythmia during EPS. Participants underwent maximal Bruce protocol exercise testing with continuous monitoring, followed by EPS. Nonparametric tests were used for analysis. Results: Participants were 17 to 67 years of age, and exercise duration ranged from 2 to 16 minutes. Exercise stress testing induced SVT in 6 patients (8.5%) among patients with EPS-inducible SVT. Exercise-induced SVT was not associated with demographic characteristics, medical history, symptom profile, or exercise capacity. Atrioventricular nodal reentrant tachycardia (AVNRT) was the most frequent SVT subtype overall and the most common subtype among exercise-induced cases. The distribution of SVT subtypes differed significantly according to exercise-induced SVT status. Metabolic equivalents were inversely correlated with age and body mass index. Conclusions: Concordance between exercise stress testing and EPS vis-a-vis SVT induction was low among patients with EPS-inducible SVT. Exercise-induced SVT was not associated with clinical or demographic parameters. Although AVNRT was the most common induced subtype, the limited concordance supports a restricted role for exercise testing in provoking SVT before EPS. (Iranian Heart Journal 2026; 27(3): 60-70). © 2026, Iranian Heart Association. All rights reserved.