Elsevier

American Heart Journal

Volume 112, Issue 5, November 1986, Pages 998-1003
American Heart Journal

Exercise testing after correction of tetralogy of Fallot: The fallacy of a reduced heart rate response

https://doi.org/10.1016/0002-8703(86)90312-1Get rights and content

Abstract

Thirty-nine patients, 5 to 19 years of age, were studied 1 to 10.5 years (mean 4.5) after surgical correction of tetralogy of Fallot (TF). In 32 of them the results of an exercise performance test based on heart rate response to submaximal exercise (V̇O2, 170 [bpm]) was compared with another index of physical performance capacity, which is independent from heart rate: the ventilatory threshold. In patients operated for TF, the mean heart rate during exercise was significantly lower than that corresponding to the same level of exercise in normal children (p < 0.001) and their mean V̇O2, 170 was normal. Theoretically, these findings could be interpreted as indicating a normal or high physical performance capacity. By contrast, the ventilatory threshold was significantly lower than that in normal childen: it averaged 89.3 ± 15.7%, 79.7 ± 14.4%, and 88.5 ± 15.8% of the mean value in normal children matched for age, weight, and height, respectively. More patients had a subnormal value for ventilatory threshold than for V̇O2, 170:58% had a ventilatory threshold below the 95% confidence limits for age-matched normal individuals and 75% had a subnormal value when compared to weight-matched normal children. For V̇O2, 170, these values were 39% and 34%, respectively (p < 0.05). We recommend the evaluation of the exercise performance capacity in patients operated for TF not only by measuring heart rate response and V̇O2, 170 which may be misleading because of relative bradycardia, but also by analyzing gas exchange and determining the ventilatory threshold.

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