1. Safety and efficacy of in-hospital cardiac rehabilitation following antiarrhythmic therapy for patients with electrical storm
- Author
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Masafumi Takahashi, Hirotomo Konno, Jo Kato, Akihiko Nogami, Akira Koike, Yuta Takayanagi, Kenji Kuroki, Kazutaka Aonuma, and Yukio Sekiguchi
- Subjects
Male ,medicine.medical_specialty ,Defibrillation ,medicine.medical_treatment ,Hospitals, Rehabilitation ,030204 cardiovascular system & hematology ,Bed rest ,Ventricular tachycardia ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Internal medicine ,Activities of Daily Living ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Univariate analysis ,Cardiac Rehabilitation ,Rehabilitation ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Treatment Outcome ,Ventricular Fibrillation ,Ventricular fibrillation ,Tachycardia, Ventricular ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
- Published
- 2019
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