Cardiac rehabilitation in LVAD patients : Aspects regarding exercise and rhythm

Abstract

After implantation of aleft ventricular assist device (LVAD), it is strongly recommended that patients participate in an inpatient cardiac rehabilitation program (CR). Relevant topics during CR include sports and exercise therapy as well as aspects of cardiac rhythm control. Over time, LVAD patients usually regainagood quality of life and an adequate functional capacity can be observed. However, maximum performance values remain markedly reduced, in part due to the fixed LVAD pump speed and the limited total cardiac output. Therefore, structured long-term exercise training programs (even beyond CR phaseII) are of particular importance in order to optimize neuromuscular control and muscle metabolism. Limitations to physical performance values may also be caused by the occurrence of supraventricular and/or ventricular arrhythmias. In both cases, the cause is an increasing hemodynamic impairment of the right heart, which may also lead to areduced LVAD pump flow. In addition, inadequate setting of other cardiac implantable electronic devices (e.g., implantable cardioverter-defibrillator [ICD] or cardiac resynchronization therapy with defibrillator [CRT-D]) may also have acrucial impact on hemodynamics after LVAD implantation. In this article, we will discuss specific aspects of LVAD therapy related to exercise and rhythm control, particularly in the context of CR programs.