{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:20:20Z","timestamp":1778685620400,"version":"3.51.4"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec id=\"ab-hbr260005-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic syndrome in which exercise stress testing is the primary method for provoking adrenergically mediated ventricular arrhythmias. Traditional exercise testing protocols, such as the Bruce protocol, may lack sensitivity, leading to missed diagnoses and undertreatment, whereas early pilot data suggest that a sudden high-intensity Burst protocol may better unmask arrhythmias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic yield and therapeutic impact of the Burst exercise stress testing protocol compared with the traditional Bruce protocol in CPVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study included pediatric and adult patients evaluated for CPVT at 2 tertiary referral centers in Vancouver, British Columbia, Canada.<\/jats:p>\n                    <jats:p>Data were collected from May 2017 through May 2024, and data analysis was performed from May 2024 through April 2025. Of 38 screened patients, 28 were included who had undergone consecutive Bruce and Burst exercise tests, with available tracings and a diagnostic phenotype on at least 1 test. Arrhythmia severity was scored using the Ventricular Arrhythmia Score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Type of exercise stress testing protocol (Bruce vs Burst).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main outcome was the Ventricular Arrhythmia Score (ranging from 0\u2009=\u2009no premature ventricular contractions to 4\u2009=\u2009nonsustained ventricular tachycardia). Other outcomes included changes in pharmacologic therapy and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort included 13 female patients (46%) and 18 probands (64%), including 23 (82%) with a causative\n                      <jats:italic toggle=\"yes\">RYR2<\/jats:italic>\n                      variant. Median (IQR) age at testing was 19.9 (14.8-33.9) years for Bruce testing and 21.0 (16.1-35.5) years at Burst testing. Bruce and Burst exercise tests were performed a median (IQR) of 1.3 (0.6-2.0) years apart, with all Burst tests performed on equivalent or intensified therapy. The Burst protocol provoked more severe arrhythmias in 20 of 28 patients (71%) with a higher median (IQR) Ventricular Arrhythmia Score (3 [2-4] vs 1 [1-2];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). These findings prompted \u03b2-blocker or flecainide initiation or dose escalation in 13 patients (65%). No adverse safety events occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260005-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, the Burst exercise stress testing protocol detected a greater burden and severity of ventricular arrhythmias than the Bruce protocol in patients with CPVT, frequently prompting treatment escalation without observed safety concerns. These data suggest that incorporating Burst protocol exercise stress testing into the routine care of patients with CPVT is low risk and often informative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.0384","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:00:34Z","timestamp":1775660434000},"page":"464","source":"Crossref","is-referenced-by-count":0,"title":["Burst Exercise Stress Testing in Catecholaminergic Polymorphic Ventricular Tachycardia"],"prefix":"10.1001","volume":"11","author":[{"given":"Borna","family":"Naderi","sequence":"first","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher O. Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brianna","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dania","family":"Kallas","sequence":"additional","affiliation":[{"name":"Children\u2019s Heart Centre, Division of Cardiology, British Columbia Children\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary W. M.","family":"Laksman","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Franciosi","sequence":"additional","affiliation":[{"name":"Children\u2019s Heart Centre, Division of Cardiology, British Columbia Children\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shubhayan","family":"Sanatani","sequence":"additional","affiliation":[{"name":"Children\u2019s Heart Centre, Division of Cardiology, British Columbia Children\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D.","family":"Krahn","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Roston","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Innovation, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Cardiology, St Paul\u2019s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"12","key":"hbr260005r1","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1016\/j.hrthm.2013.05.014","article-title":"HRS\/EHRA\/APHRS expert consensus 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