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Brief Reports |15 June 1994

Asystole after Exercise in Healthy Persons

Stefan Osswald, MD; Ross Brooks, MD; Sean S. O'Nunain, MD; Jay H. Curwin, MD; Marc Roelke, MD; Paul Radvany, MD; Jeremy N. Ruskin, MD; Brian A. McGovern, MD

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Copyright ©2004 by the American College of Physicians
2004
  • From Massachusetts General Hospital, Boston, Massachusetts; St. Peter's Hospital, Albany, New York. Requests for Reprints: Brian A. McGovern, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114. Grant Support: Stefan Osswald is the recipient of a research fellowship granted by the Swiss Lichtenstein Foundation.
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Exercise-related syncope is infrequent in healthy persons, although vasodepressor syncope reproduced by positive head-up tilt testing has been reported in small series of healthy persons [1] and athletes [2] with syncope after exercise. Whether vasodepressor syncope may also occur during exercise is controversial and is now an issue of public debate [3]. Asystole after exercise is an extremely rare finding in healthy persons, and single cases without clear proof of the underlying mechanisms have been reported during the past 20 years [4-7]. We describe three patients with recurrent exercise-related syncope in whom prolonged asystole after exercise was documented. Positive head-up tilt table testing in all three patients suggested neurocardiogenic syncope as the underlying mechanism.
A 34-year-old man had atypical chest pain and a history of multiple episodes of syncope and presyncope, all related to physical stress. Two syncopal episodes occurred immediately after weight lifting. Submaximal exercise test results did not indicate ischemia. However, 1.5 minutes into recovery, the patient developed sudden asystole (lasting for 32 seconds) with rare ventricular escape beats (Figure 1). This resulted in respiratory arrest, and chest massage was initiated by the supervising physician; the patient recovered just before being intubated. Fifteen months later, he had another syncopal episode while walking into the bathroom at night. A chest radiograph, a 12-lead electrocardiogram, 24-hour Holter monitoring, and an echocardiogram all yielded normal test results. Head-up tilt testing was done, and, after 4 minutes in the upright position, the patient became abruptly asystolic for 23...
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Osswald S, Brooks R, O'Nunain SS, et al. Asystole after Exercise in Healthy Persons. Ann Intern Med. 1994;120:1008–1011. doi: 10.7326/0003-4819-120-12-199406150-00007

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Published: Ann Intern Med. 1994;120(12):1008-1011.

DOI: 10.7326/0003-4819-120-12-199406150-00007

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