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.
Kamke
W
W
Klinik am See, Department of Cardiology Rehabilitation, Center of Cardovascular Diseases, Seebad 84, 15562 Rüdersdorf/Berlin, Germany.
Dovifat
C
C
Schranz
M
M
Behrens
S
S
Moesenthin
J
J
Völler
H
H
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