The Personalized Precise Exercise Training Holistic Integrative Protocol (PPET‐HIP) for Patient with Myocardial Incompetence and Catecholamine‐Sensitive Ventricular Arrhythmia after her Sudden Cardiac Arrest

Abstract

INTRODUCTIONSThe patient was a 23yrs female nurse in Fuwai‐hospital. After 2d overtime work, she had suddenly cardiac arrested followed by successful CPR and 5hr unconsciousness. Afterward she was diagnosed as catecholamine‐sensitive ventricular tachycardia, myocardial insufficiency and etc; and some physicians suggested installing of cardiac pacemaker with ICD. However, based on HIPM, we believe her main problem was the mismatching of supply‐demand and poor integration among systems, and Personalized Precise exercise Training Holistic Integrative Protocol (PPET‐HIP)can reverse those. We suggested give us ~100d PPET‐HIP and then decide for pacemaker‐ICD.METHODSAfter performing symptom limited maximum cardiopulmonary exercise testing (CPET) for objectively quantitative evaluation, we generated her PPET‐HIPΔ50% Power for intensity titration. According to results of continuous beat‐by‐beat blood pressure and continuous blood glucose monitoring during 30min Δ50% Power intensity titration we did select qid, 6d/w intensive management.RESULTSAfter 1m of intensive management, her continuation duration of PPET‐HIP was increased from 1–2min to 6–7min. The total exercise duration was increased from 17 to 24min, and resting was decreased from 8–10 to 3–4 times/30min. In 1st CPET, ventricular premature (PVC) began from loading intensity over 75w/min until peak loading127.5W/min , and total PVC was 119beat/130s.After three‐month PPET‐HIP,CPET showed PVC began from loading intensity over 100w/min until peak loading 162.5W/min , and total PVC was 68beat/170s. Comparing with the 1st one, three‐month CPET’s key parameters of peakVO2, AT, peak loading, peak CO and oxygen uptake efficiency plateau (OUEP) were increased by 20.1%, 15.2%, 21.5% and 22.5%, 21.7% and 5.7% respectively, only VE/VCO2 was decreased by 5.4%; all indicated improvement of functional status. The she has been believed that she couldn’t be nursing work again. However, after leaving Fuwai, she has become a clinical nurse again and working in cardiac rehabilitation, which is very meaningful for her.CONCLUSION Under the guidance of HIPM, we could safely and effectively manage patients by PPET‐HIP. Increased functional capacity parameters in CPET by 5–23%. Increased threshold of PVC and decreased rate of PVC during CPET. Decreased number of PVC and decreased rate of PVC in 30min training of PPET‐HIP.Support or Funding InformationNational Natural Science Foundation of China (81470204);Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02);Research on Clinical Characteristics of the Capital (Z141107002514084);Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)