Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators

Iliou, Marie Christine; Blanchard, Jean-Christophe; Lamar-Tanguy, Aurélia; Cristofini, P.; Ledru, François

doi:10.4081/monaldi.2016.756

Cited by 31 publications

(41 citation statements)

References 28 publications

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“…However, CR is a comprehensive management program including patient education, nutrition consultation, close monitoring, lifestyle guidelines, and psychosocial support (Price et al, 2016). Additionally, telemonitoring of CRT devices is becoming increasingly important in long-term CR programs to adjust exercise prescription and improve adherence timely (Iliou et al, 2016). Further evidence is needed to standardize CR programs for patients with CRT.…”

Section: Discussionmentioning

confidence: 99%

“…HF patients with indications of CRT implantation tend to have a higher level of NYHA functional class (Yancy et al, 2013). Some experts have proposed that CRT is usually programmed at rest, and an exercise test may detect a loss of resynchronization during exercise training, which may weaken the benefits of CRT (Iliou et al, 2016). However, several studies also reported that exercise rehabilitation might result in a better response to CRT in HF patients (Conraads et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

Wang

2020

Front. Physiol.

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Background: Many heart failure (HF) patients admitted to cardiac rehabilitation (CR) centers have a cardiac resynchronization therapy (CRT) device. However, information about the efficacy and safety of exercise rehabilitation in HF patients with a CRT device is scant. We assessed the effects of exercise rehabilitation in HF patients with a CRT device. Methods and Results: The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, China Biology Medicine, Wanfang, and China National Knowledge Infrastructure databases were searched comprehensively to identify randomized controlled trials (RCTs) published between January 1, 1990 and July 1, 2019 on exercise rehabilitation in HF patients with CRT devices. We identified seven studies published from 2006 to 2019, including 661 patients with an intervention duration of 8 to 24 weeks. Three studies reported all-cause mortality and serious adverse events, and no significant difference was found between exercise rehabilitation patients and controls at the longest available follow-up (both P > 0.05; both I 2 = 0%). Exercise rehabilitation patients exhibited a higher exercise capacity (peak oxygen uptake: random-effect WMD = 2.02 ml/kg/min, 95% CI 0.62 to 3.41, P = 0.005, I 2 = 67.4%; exercise duration: fixed-effect WMD = 102.34s, 95% CI 67.06 to 137.62, P < 0.001, I 2 = 25%) after intervention, despite the significant heterogeneity of studies. Left ventricular ejection fraction (LVEF) was significantly improved in exercise rehabilitation patients compared to that in controls (fixed-effect WMD = 3.89%, 95% CI 1.50 to 6.28; P = 0.001; I 2 = 48.0%). Due to differences in health-related quality of life (HRQOL) assessment methods, we only pooled data that reported Minnesota Living with Heart Failure Questionnaire scores. Exercise rehabilitation patients exhibited a better HRQOL than controls (fixed-effect WMD = −5.34, 95% CI −10.12 to −0.56; P = 0.028; I 2 = 0%). Conclusions: Exercise rehabilitation may restore exercise capacity and cardiac function in HF patients with a CRT device. Furthermore, exercise training was associated with better HRQOL on follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

Wang

2020

Front. Physiol.

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“…These improvements appear to be reasonably explained by both the enhancement of cardiac function induced by the device and by the improved peripheral (muscular and vascular) effects of exercise [10]. Exercise performance changes have been evaluated in terms of increased 6-minute walk test distance, increased treadmill exercise duration, increased VO 2 peak, and increased anaerobic threshold among different studies, and generally were associated with improvements of hemodynamic status, quality of life, quality of sleep, depression and endothelial dysfunction [11][12][13][14].…”

Section: Effects Of Exercise In Patients With Cardiac Resynchronizatimentioning

confidence: 98%

Exercise-based cardiac rehabilitation in cardiac resynchronization therapy recipients: A primer for practicing clinicians

Ambrosetti

Braga

Giada³

et al. 2017

Monaldi Arch Chest Dis

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Cardiac resynchronization therapy (CRT) is a therapeutic option of increasing importance for chronic heart failure (CHF) and criteria for implantation now concern a large amount of patient populations. As a consequence, subjects with ongoing CRT (or immediately after CRT implantation) are more often referred to Cardiac Rehabilitation (CR) programmes, and it has been recently estimated that about one third of CHF patients attending CR in Italy currently have this kind of device. The presence of CRT represents a modulating factor for exercise prescription and monitoring, since CRT patients may be considered per se as a target group for CR. Exercise therapy (ET) increases benefits from CRT on functional capacity, and recent evidence suggests an adjuvant role of ET in improving cardiovascular prognosis also. Both aerobic endurance and resistance training activities may involve CHF patients with CRT, while the potential role of aerobic interval training needs more studies and evidence. Prescription of an ET program should be associated with information regarding device programming and possible limiting factors associated with pacing therapy, tailoring of the basic principles of ET (in terms of type of exercise, intensity and program duration) in this patient group is mandatory. Cardiac resynchronization therapy in heart failureHeart failure (HF) is a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling and fatigue) leading to marked disability and impaired life expectancy. The prevalence of HF is approximately 1-2% of the adult population in developed countries, rising to ≥10% among people >70 years of age [1][2][3]. Cardiac resynchronization therapy (CRT) represents an important advancement in HF treatment by targeting ventricular dyssynchrony, a condition occurring in up to a third of patients with severe systolic HF [4]. CRT is based on the addiction of a third left ventricular pacing lead to a standard pacemaker (CRT-P) or defibrillator system (CRT-D) that generally includes only two right side leads (Figure 1) The left side lead is generally placed into the lateral or posterolateral wall of the left ventricle, and when the two leads are activated, a coordinated pacing of the left ventricle and right ventricle is obtained [5]. Several randomized, controlled clinical studies have demonstrated that CRT has several positive clinical effects, including: improvement in cardiac function and structure, quality of life and exercise capacity, as well as reduction in heart failure hospitalization and mortality from progressive heart failure (Table 1). Moreover, by improving cardiac performance and efficiency, CRT favorably impacts cardiac autonomic control, potentially contributing to reverse remodeling of the left ventricle [6]. As in the case of implantable cardioverter defibrillator (ICD) devices [7], implantation policies may have significant impact on public health expenditure and appropriate patient selection for CRT is needed in order to maximize its benefits and cost-eff...

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“…Pacemakers and internal defibrillators are capable of adjusting the heart rhythm to help the patient adapt to physical training: in patients with bradyarrhythmias, they prevent the heart rate to drop under a certain limit (usually 60-70 beats/min), in patients with chronotropic incompetence (failure to increase the heart rate during exercise) some pacemakers have the option to detect the level of exercise performed by the patient and to increase the heart rate accordingly (rate responsive function), some pacemakers are programmed with algorithms that favor the intrinsic activation of the ventricles during exercise, activation that produces a much more effective contraction compared to the activation delivered by the right ventricular apical pacing, dual-chamber pacemakers maintain the atrioventricular synchronism in patients in sinus rhythm (each atrial contraction followed by a ventricular contraction), internal defibrillators detect life-threatening arrhythmias and deliver specific electrical therapies (anti-tachycardia pacing, internal electrical shock) [14,15,16].…”

Section: Specific Complications Related To Intracardiac Devicesmentioning

confidence: 99%

The role of cardiopulmonary exercise testing in the initial evaluation of patients wearing intracardiac devices submitted to cardiac rehabilitation

Caloian¹,

Pop²,

Gușetu³

et al. 2017

Balneo

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Cardiopulmonary exercise testing(CPET) can be used to determine the maximum exercise capacity, to identify the factors that cause a limitation of the patient's functional capacity, to evaluate symptoms triggered by physical exercise and to reveal specific complications related to intracardiac devices that might occur during the physical rehabilitation program. The rehabilitation of a patient that is wearing an intracardiac device raises some particular issues besides the ones that we meet in a conventionally treated cardiovascular patient. Several clinical studies have shown that the programming mode of the cardiac pacemakers can have a significant influence on the patients exercise capacity, a crucial element of any physical rehabilitation program. CPET is one of the most accurate and comprehensive methods for the evaluation of the pacemaker-wearing patients, being able to optimize their functional capacity and, therefore, should be recommended in all patients before inclusion in cardiac exercise rehabilitation programs.

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Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators

Cited by 31 publications

References 28 publications

Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

Exercise-based cardiac rehabilitation in cardiac resynchronization therapy recipients: A primer for practicing clinicians

The role of cardiopulmonary exercise testing in the initial evaluation of patients wearing intracardiac devices submitted to cardiac rehabilitation

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