@Article{chd.12864,
AUTHOR = {Varun Aggarwal, Kristen Sexson-Tejtal, Wilson Lam, Santiago O. Valdes, Caridad M. de la Uz, Jeffrey J. Kim, Christina Y. Miyake},
TITLE = {The incidence of arrhythmias during exercise stress tests among children with Kawasaki disease: A single-center case series},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1032--1036},
URL = {http://www.techscience.com/schd/v14n6/38933},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Based on 2017 guidelines, participation in competitive sports with prior 
history of Kawasaki Disease (KD) requires those with coronary artery aneurysms 
(CAA) z score ≥ 5 to undergo evaluation for evidence of inducible ischemia or arrhythmias. The use of exercise stress testing (EST) to evaluate arrhythmias among KD 
patients has never been reported. This retrospective single-center case series study 
sought to describe the presence of inducible arrhythmias during EST in KD patients 
with or without CAA.<br/>
<b>Methods:</b> Single-center retrospective review of medical records of patients diagnosed with KD between 1989-2015 at Texas Children’s Hospital, Houston, Texas 
who underwent EST were included.<br/>
<b>Results:</b> Among 1007 patients diagnosed with KD, 95 (9%) underwent 165 ESTs at a 
median time of 9.6 years (IQR 5.8-11.3 years) from diagnosis. Of these 95 patients, 37 
had normal coronaries, 21 dilated (z score 2 to <2.5), 10 small (5 >z ≥2.5), 12 medium 
(10>z ≥ 5 absolute dimension <8 mm), 10 large (z ≥10 or absolute dimension ≥8 mm), 
5 severe (myocardial infarct or bypass graft). Supraventricular tachycardia was not 
seen. Ventricular arrhythmias during EST were uncommon and seen only among patients with CAA z ≥5. Ventricular tachycardia occurred in a single patient with a large 
CAA, known VT and ICD. High-grade ventricular ectopy was seen in one patient who 
had severe CAA and underwent bypass grafting.<br/>
<b>Conclusions:</b> Arrhythmias on EST were noted only among patients with CAA z ≥5. 
The current guidelines are a reasonable approach to increasing healthy activity 
among KD patients. Clarification regarding which inducible arrhythmias meet criteria 
for activity restriction may be helpful to guide sport participation.},
DOI = {10.1111/chd.12864}
}