Cardiac Rehabilitation in Patients With Implantable Cardioverter-Defibrillator: A Scoping Review

Sudden cardiac death (SCD) represents a serious global health problem. Therefore, an implantable cardioverter-defibrillator (ICD) is indicated in various clinical conditions as a strategy for the primary and secondary prevention of SCD. These patients benefit from a cardiac rehabilitation (CR) program aimed at improving cardiorespiratory fitness, increasing exercise tolerance, and reducing the fear of physical activity. This review aims to describe the outcomes of exercise-based CR in patients with an ICD.

A scoping review was performed following the methodology described in the Joanna Briggs Institute Manual, the protocol presented by Arksey and O'Malley, and the improvements suggested by Levac, Colquhoun, and O'Brien. This review included defining the research question, identifying relevant studies, and systematic searches of databases: PubMed, Google Scholar, Science Direct, Lilacs, SCOPUS, Embase, Epistemonikos, and PEDro (Physiotherapy Evidence Database).

Four articles were included. The authors implemented a combined training program with aerobic exercise and strength training, almost all with 12 12-week duration. Most worked between 50% and 80% of maximum heart rate, and the suggested maximum target heart rate was 10-20 beats below the activation threshold of the implantable cardioverter defibrillator. CR generates an improvement in cardiopulmonary parameters without adverse cardiac events, with a low probability of presenting shocks due to episodes of tachycardia or ventricular fibrillation during exercise sessions.

The literature analyzed suggests that exercise-based CR in patients with an ICD is a safe intervention, with a low complication rate, that generates significant improvement in VO2, MET, distance covered in the 6-min walk, impacting the quality of life and functionality of patients.