Serkan BEKTUR
Experimental and Applied Medical Science - 2026;7(3):183-192
Introduction: The physiological impact of surgical face masks on exercise-induced arrhythmias remains poorly understood. This study aimed to evaluate changes in premature ventricular contraction (PVC) burden during exercise stress testing performed with and without surgical masks. Methods: We retrospectively analyzed 41 patients (mean age 54.2 +/- 11.3 years, 58.5% male) who underwent paired exercise ECG stress testing with and without face mask. The median interval between the two exercise tests was 61 days (range: 25-76 days). Exercise testing was performed according to the standard Bruce treadmill protocol. Twelve-lead ECG monitoring was continuously recorded throughout exercise and recovery, and tests were terminated according to standard guideline-based criteria. PVC burden was calculated as the ratio of PVC beats to total beats during exercise. Paired comparisons were performed using paired t-tests or Wilcoxon signed-rank tests, as appropriate. Results: PVC burden was significantly higher during masked testing (0.91% +/- 0.38) compared to unmasked testing (0.52% +/- 0.25) (p < 0.001). The mean paired increase was 0.39% (95% CI 0.29-0.49%), corresponding to a large effect size (Cohen's d = 1.22). Twenty-nine patients (70.7%) demonstrated a higher PVC burden during masked testing, and 18 patients (44.0%) showed an increase greater than 0.3%. No sustained arrhythmias or premature test terminations occurred. Discussion and conclusion: Surgical face mask use during exercise stress testing is associated with increased PVC burden and may be related to physiological alterations involving ventilation and autonomic activation. Awareness of this effect is important for interpretation of exercise-induced arrhythmias during masked testing. Further prospective studies incorporating oxygen saturation and autonomic monitoring are warranted.
