Response to exercise in congenital complete atrioventricular block.

In 8 patients aged 8 to 17 years with congenital complete atrioventricular (AV) block, exercise testing was performed on a treadmill. Cardiorespiratory endurance performance was assessed by determination of the ventilatory threshold. The mean value for ventilatory threshold was significantly lower (p less than 0.005) than the normal mean value and averaged 76 +/- 16%, 75 +/- 17% and 75 +/- 16% of the predicted normal value in children of the same sex and comparable age, weight and height, respectively. The ventricular rate at rest varied from 36 to 56 beats/min and increased to a mean value of 106 +/- 25 on exercise. When expressed as a percentage of the normal value, the heart rate was subnormal (below the 95% confidence limit) in all patients, throughout different exercise levels. For the same exercise intensity the oxygen uptake, expressed as ml/min/kg, was significantly lower (p less than 0.02) in patients than in normal individuals. This suggests an inadequate hemodynamic adjustment to the relative exercise bradycardia and a higher than normal anaerobic/aerobic energy supply. Exercise testing was found to be useful in the assessment of congenital AV block, because the resting heart rate did not permit prediction of the relative exercise bradycardia or the degree of exercise intolerance.