title: Impact of descent and stay at a Dead Sea resort (low altitude) on patients with systolic congestive heart failure and an implantable cardioverter defibrillator.
abstract: BACKGROUND
  As the lowest natural site on earth (-415 meters), the Dead Sea is unique for its high pressure and oxygen tension in addition to the unparalleled combination of natural resources. Furthermore, its balneotherapeutic resorts have been reported to be beneficial for patients with various chronic diseases.
  
  
  OBJECTIVE
  To evaluate the safety, quality of life (QoL), exercise capacity, heart failure, and arrhythmia parameters in patients with systolic congestive heart failure (SCHF) and implantable cardioverter defibrillator (ICD) following descent and stay at the Dead Sea.
  
  
  METHODS
  The study group comprised patients with SCHF, New York Heart Association functional class II-III after ICD implantation. The following parameters were tested at sea level one week prior to the descent, during a 4 day stay at the Dead Sea, and one week after return: blood pressure, 02 saturation, ejection fraction (echocardiography), weight, B-type natriuretic peptide (BNP), arrhythmias, heart rate, heart rate variability (HRV), and QoL assessed by the Minnesota Living with Heart Failure questionnaire.
  
  
  RESULTS
  We evaluated 19 patients, age 65.3 +/- 9.6 years, of whom 16 (84%) were males and 18 (95%) had ICD-cardiac resynchronization therapy. The trip to and from and the stay at the Dead Sea were uneventful and well tolerated. The QoL score improved by 11 points, and the 6 minute walk increased by 63 meters (P < 0.001). BNP levels increased slightly with no statistical significance. The HRV decreased (P = 0.018). There were no significant changes in blood pressure, weight, 02 saturation or ejection fraction.
  
  
  CONCLUSIONS
  Descent to, ascent from, and stay at a Dead Sea resort are safe and might be beneficial in some aspects for patients with SCHF and an ICD.
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Isack
authors.initials: I
authors.lastname: Gabizon
authors.forename: Arthur
authors.initials: A
authors.lastname: Shiyovich
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khalameizer
authors.forename: Chaim
authors.initials: C
authors.lastname: Yosefy
authors.forename: Shimon W
authors.initials: SW
authors.lastname: Moses
authors.forename: Amos
authors.initials: A
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000531:Altitude; D001274:Atmospheric Pressure; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004781:Environmental Exposure; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006294:Health Resorts; D054143:Heart Failure, Systolic / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009792:Oceans and Seas; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome