title: Neuromuscular electrical stimulation of the thighs in cardiac patients with implantable cardioverter defibrillators.
abstract: BACKGROUND
  The aim of this systematic review was to update scientific knowledge concerning the safety of neuromuscular electrical stimulation (NMES) to increase exercise capacity and prevent cardiac cachexia in patients with implantable cardioverter defibrillators (ICDs).
  
  
  METHODS
  A systematic review including the electronic databases PubMed, MEDLINE, and SCOPUS was conducted for the time period from 1966 to March 31, 2016.
  
  
  RESULTS
  Only four articles fulfilled the inclusion criteria (three original articles/safety studies and one case report). The three (safety) studies used NMES to increase muscle strength and/or endurance capacity of the thighs. NMES did not show electromagnetic interference (EMI) with ICD function. EMI was described in a case report of 2 patients with subpectoral ICDs and application of NMES on abdominal muscles.
  
  
  CONCLUSIONS
  This review indicates that NMES may be applied in cardiac ICD patients if 1) individual risks (e. g., pacing dependency, acute heart failure, unstable angina, ventricular arrhythmic episode in the last 3 months) are excluded by performing a safety check before starting NMES treatment and 2) "passive" exercise using NMES is performed only for thighs and gluteal muscles in 3) compliant ICD patients (especially for home-based NMES) and 4) the treatment is regularly supervised by a physician and the device is examined after the first use of NMES to exclude EMI. Nevertheless, further studies including larger sample sizes are necessary to exclude any risk when NMES is used in this patient group.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Fadime
authors.initials: F
authors.lastname: Cenik
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.|Department of Cardiology, Hanusch-Krankenhaus, Vienna, Austria.
authors.forename: Dieter
authors.initials: D
authors.lastname: Schoberwalter
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Keilani
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.|Therapiezentrum Rosalienhof, Versicherungsanstalt öffentlich Bediensteter, Bad Tatzmannsdorf, Austria.
authors.forename: Bruno
authors.initials: B
authors.lastname: Maehr
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
authors.affiliation: Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Marhold
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. richard.crevenna@meduniwien.ac.at.
authors.forename: Richard
authors.initials: R
authors.lastname: Crevenna
mesh_terms: D002100:Cachexia / Q000453:epidemiology* / Q000534:rehabilitation*; D000075202:Contraindications; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004556:Electric Injuries / Q000453:epidemiology; D004599:Electric Stimulation Therapy / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data; D004869:Equipment Safety / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015995:Prevalence; D013848:Thigh / Q000294:innervation
keywords: Electromagnetic interference; Heart failure; Implantable cardioverter defibrillator; Neuromuscular electrical stimulation; Risk