Safety and efficacy of in-hospital cardiac rehabilitation following antiarrhythmic therapy for patients with electrical storm

•Activities of daily living (ADL) levels in some patients with electrical storm worsened due to bed rest.•In-hospital rehabilitation had beneficial effects on deteriorated ADL levels.•Ventricular tachycardia/ventricular fibrillation recurrence in the patients receiving rehabilitation did not increas...

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Bibliographic Details
Published in:Journal of cardiology 2019-02, Vol.73 (2), p.171-178
Main Authors: Kato, Jo, Koike, Akira, Kuroki, Kenji, Takayanagi, Yuta, Takahashi, Masafumi, Konno, Hirotomo, Sekiguchi, Yukio, Nogami, Akihiko, Aonuma, Kazutaka
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
Anti-Arrhythmia Agents - therapeutic use
Cardiac rehabilitation
Cardiac Rehabilitation - methods
Electrical storm
Female
Hospitals, Rehabilitation
Humans
Male
Middle Aged
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Factors
Safety
Tachycardia, Ventricular - rehabilitation
Treatment Outcome
Ventricular Fibrillation - rehabilitation
Ventricular Function, Left
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Summary:•Activities of daily living (ADL) levels in some patients with electrical storm worsened due to bed rest.•In-hospital rehabilitation had beneficial effects on deteriorated ADL levels.•Ventricular tachycardia/ventricular fibrillation recurrence in the patients receiving rehabilitation did not increase.•However, early initiation of rehabilitation was unfavorable for the recurrence. Exercise-based in-hospital rehabilitation for patients with electrical storm (ventricular tachycardia/ventricular fibrillation, VT/VF) following antiarrhythmic therapy may prevent the deleterious outcomes of prolonged immobility, but the safety and efficacy of this strategy are still uncertain. We retrospectively investigated the rate of electrical storm recurrence in patients receiving rehabilitation. Sixty-seven patients receiving therapy for electrical storm were included in this study. After treatment, patients were divided into rehabilitation (n=39) and non-rehabilitation (n=28) groups. Incidences of electrical storm recurrence and VT/VF requiring anti-tachycardia pacing or electrical defibrillation did not differ significantly between the rehabilitation and non-rehabilitation groups (13% vs. 21% and 28% vs. 25%, respectively). However, early mobilization initiated ≤2 days after primary therapy was disadvantageous for electrical storm and VT/VF recurrence compared to later mobilization (21% vs. 6% and 34% vs. 19%, respectively). Although the activities of daily living (ADL) at admission were significantly lower in the rehabilitation group, the scores were restored to the level of the non-rehabilitation group at the time of discharge. Univariate analysis revealed that high B-type natriuretic peptide (hazard ratio [HR]: 3.2; 95% confidence interval [CI]: 1.1–11), decreased left ventricular ejection fraction, and elevated E/E′ (HR: 3.4; 95% CI: 1.1–11) were associated with VT/VF recurrence. The incidence of electrical storm relapse is substantial following antiarrhythmic therapy, but it is not increased by in-hospital rehabilitation. Although caution is urged for early mobilization, sustaining mobility to resume activity is recommended because ADL levels tend to deteriorate as a result of prolonged bed rest.
ISSN:0914-5087
1876-4738
DOI:10.1016/j.jjcc.2018.08.004