Safety and Benefits of Cardiac Rehabilitation for Patients with an Implantable Cardioverter Defibrillator (ICD)

Abstract

Purpose: Patients with ICD are not routinely referred to cardiac rehabilitation (CR) due to fears that exercise may induce ventricular arrhythmias. This study was conducted to establish the safety and benefits of CR, including exercise training and testing, in patients with ICD. Methods: Consecutive patients with ICD who entered a single comprehensive tertiary CR program in Western Sydney from 1997 to 2010, with six months follow-up, were included. Prospective data was analysed including program mortality and morbidity, functional capacity (exercise stress testing (EST); six minute walk test (6MWT)), left ventricular ejection fraction (LVEF %), demographics, medications, and quality of life. Results: In this study, 161 patients with ICD had 178 presentations to CR (mean age: 61 ± 10.16; 85% male; LVEF (%) 30 ± 10.38). No admissions for mortality or morbidity were seen in this study group while exercising or having a functional capacity test. Completion rate was 62% (dropout rate for non medical reasons being 14%). There were four deaths (2%) in this study group. Hospital admissions, which occurred whilst on the CR program, were due to: ICD activations (0.5%), displaced lead (1%), acute heart failure (3%), percutaneous coronary interventions (1%), and stroke (0.5%). Functional capacity increased significantly (EST pre CR 6.9 ± 2.2 METS: post CR 9.6 ± 2.8 METS; p < 0.001; 6MWT pre CR 373 ± 121 m: post CR 430 ± 124 m, p = 0.04). Quality of life indicators also improved post CR. Conclusion: Exercise is deemed safe in this group of patients. The ICD patients also gained significant functional capacity and quality of life outcomes.