Cardiac rehabilitation in patients with implantable defibrillators. Feasibility and complications.
OBJECTIVE
We examined patients with implantable cardioverter defibrillators (ICD) in order to demonstrate their safe participation in a standard rehabilitation program.


METHODS
Prospective cohort study of a consecutive series of patients after ICD implantation. Setting Inpatient rehabilitation center.


METHODS
A total of 118 patients (73.7% male, mean age 60+/-11 years) took part for 23 +/- 4 days in a standard inpatient rehabilitation program including physical activity, psychological care, heart function seminars, and resuscitation exercises with family members. The following noninvasive tests were performed: symptomlimited exercise testing, two-dimensional echocardiography, Holter monitoring, telemetric ICD interrogation, optional fluoroscopy or X-ray examination of the thorax, and (in some patients) defibrillation threshold testing.


RESULTS
Out of 118 patients 101 patients (85.6%) participated in regular ergometer training during which the initial workload of 23 +/- 11 Watts could be increased to 45 +/- 18 Watts. An individual conditioning program was assigned to 15% (n = 17) patients, thereby enabling the inclusion of all patients in the rehabilitation process. Under these conditions 12 patients (10%) experienced ICD malfunctions requiring therapy. As a consequence of all cardiac function tests, ICD reprogramming was necessary in 26 patients (22.1%).


CONCLUSIONS
Following ICD implantation, patients may participate in a standard rehabilitation program without serious complications and with a significant increase in physical capacity. However, ICD malfunction occurs in approximately 10% of patients. Additional tests performed by skilled medical staff and appropriate technical equipment allows the ICD program to be optimized.
Klinik am See, Department of Cardiology Rehabilitation, Center of Cardovascular Diseases, Seebad 84, 15562 Rüdersdorf/Berlin, Germany.
W
W
Kamke
C
C
Dovifat
M
M
Schranz
S
S
Behrens
J
J
Moesenthin
H
H
Völler
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000534:rehabilitation*; D009202:Cardiomyopathies / Q000150:complications / Q000401:mortality / Q000534:rehabilitation*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000401:mortality / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000534:rehabilitation*; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005080:Exercise Test; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D026741:Physical Therapy Modalities; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate