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Cardiovascular Rehabilitation With a WCD-Data From the CR3 Study (Cardiac Rehab Retrospective Review)
Ursula Rohrer1, Anja Reischl, Martin Manninger
1Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast).
Insights
Cardiac rehabilitation is safe and feasible for patients using a wearable cardioverter-defibrillator (WCD). This approach may improve cardiac function and recovery in high-risk individuals.
Area of Science:
- Cardiology
- Medical Devices
- Rehabilitation Medicine
Background:
- Patients at risk for sudden cardiac death may require a temporary wearable cardioverter-defibrillator (WCD).
- Exercise-based cardiac rehabilitation (CR) is recommended for patients with cardiac disease.
Purpose of the Study:
- To evaluate the safety and feasibility of undergoing cardiac rehabilitation (CR) while using a wearable cardioverter-defibrillator (WCD).
Main Methods:
- Retrospective analysis of patients who completed CR with a WCD in Austria between 2010 and 2020.
- Data collected included WCD usage, alarms, adverse events, and changes in left ventricular ejection fraction (LVEF).
Main Results:
- No shocks were delivered by the WCD during CR; one patient had ventricular tachycardias managed with medication.
- No severe WCD-associated adverse events occurred. LVEF significantly improved post-CR (36% to 42%).
- 53% of patients stopped WCD therapy due to LVEF improvement, with other outcomes including ICD implantation or heart transplantation.
Conclusions:
- Completing cardiac rehabilitation (CR) is safe and feasible for patients using a wearable cardioverter-defibrillator (WCD).
- CR participation may positively contribute to the restitution of cardiac function in these patients.
Purpose:
Patients at risk for sudden cardiac death may temporarily need a wearable cardioverter-defibrillator (WCD). Exercise-based cardiac rehabilitation (CR) has a class I recommendation in patients with cardiac disease. The aim of this study was to evaluate the safety and feasibility of undergoing CR with a WCD.
Methods:
We performed a retrospective analysis of all patients with a WCD who completed a CR in Austria (2010-2020).
Results:
Patients (n = 55, 60 ± 11 yr, 16% female) with a median baseline left ventricular ejection fraction (LVEF) of 36 (30, 41)% at the start of CR showed a daily WCD wearing duration of 23.4 (22, 24) hr. There were 2848 (8 [1, 26]/patient) automatic alarms and 340 (3 [1, 7]/patient) manual alarms generated. No shocks were delivered by the WCD during the CR period. One patient had recurrent hemodynamically tolerated ventricular tachycardias that were controlled with antiarrhythmic drugs.No severe WCD-associated adverse events occurred during the CR stay of a median 28 (28, 28) d. The fabric garment and the device setting needed to be adjusted in two patients to diminish inappropriate automatic alarms. Left ventricular ejection fraction after CR increased significantly to 42 (30, 44)% ( P < .001). Wearable cardioverter-defibrillator therapy was stopped due to LVEF restitution in 53% of patients. In 36% of patients an implantable cardioverter-defibrillator was implanted, 6% had LVEF improvement after coronary revascularization, one patient received a heart transplantation (2%), two patients discontinued WCD treatment at their own request (4%).
Conclusion:
Completing CR is feasible and safe for WCD patients and may contribute positively to the restitution of cardiac function.
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