title: Efficacy and safety of early comprehensive cardiac rehabilitation following the implantation of cardioverter-defibrillator.
abstract: BACKGROUND
  Implantable cardioverter-defibrillator (ICD) therapy is current the main approach to prevent sudden cardiac death. It was demonstrated that patients with ICD are characterised by worse quality of life (QOL) and exercise capacity and are prone to depressive symptoms. Thus, comprehensive rehabilitation is indicated in ICD recipients.
  
  
  OBJECTIVE
  To evaluate safety and benefits of comprehensive cardiac rehabilitation early after ICD implantation.
  
  
  METHODS
  The study group consisted of 45 patients (28 males, mean age 62.2 years) in whom a program of comprehensive cardiac rehabilitation was initiated at 6 weeks after ICD implantation. Rehabilitation consisted of two phases: 2-week inpatient Phase I and 12-week outpatient Phase II. Before and after the rehabilitation program, all patients were evaluated with transthoracic echocardiography, treadmill spiroergometric exercise test according to the modified Naughton protocol, a Polish version of the SF-36 questionnaire to assess QOL, and the Beck Depression Inventory (BDI) for depressive symptoms.
  
  
  RESULTS
  No deaths during the study and no complications or adverse events during rehabilitation or exercise testing were noted. Following comprehensive cardiac rehabilitation, we found an increase in left ventricular ejection fraction (30.09 ± 12.75 vs. 35.43 ± 13.4%; p = 0.002), peak oxygen uptake (VO₂) (21.3 ± 9.2 vs. 24.2 ± 10.3 mL/kg/min; p = 0.007) and duration of exercise (9.14 ± 3.7 vs. 9.53 ± 3.8 min; p < 0.05). An improvement was also noted in terms of depressive symptoms, as BDI score decreased (14.81 ± 9.27 vs. 12.83 ± 10.75; p = 0.020). QOL improved (p < 0.05), particularly the physical index (p = 0.02), as was the New York Heart Association class (p < 0.001). Improvement in peak VO₂ was associated with better QOL (SF-total, r = -0.34; and physical index, r = -0.36). We also found a correlation between alleviation of depressive symptoms (BDI score) and improvement of QOL (SF-total, r = 0.52).
  
  
  CONCLUSIONS
  An improvement in left ventricular systolic function, exercise capacity and QOL and a reduction of depressive symptoms were observed in patients who took part in a program of early comprehensive cardiac rehabilitation after ICD implantation. No complications or side effects during rehabilitation sessions or exercise tests were observed in the study group.
authors.affiliation: Jagiellonian University Collegium Medicum, John Paul II Hospital. jp38@interia.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Śmiałek
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.forename: Jacek
authors.initials: J
authors.lastname: Majewski
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000534:rehabilitation