Jo Kato1, Akira Koike2, Kenji Kuroki2, Yuta Takayanagi3, Masafumi Takahashi4, Hirotomo Konno4, Yukio Sekiguchi2, Akihiko Nogami2, Kazutaka Aonuma2. 1. Department of Cardiology, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki 310-0015, Japan. Electronic address: d906eb@gmail.com. 2. Department of Cardiovascular Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. 3. Clinical Laboratory, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. 4. Rehabilitation Medicine Service, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
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.
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.
Authors: Piotr Orzechowski; Ryszard Piotrowicz; Wojciech Zareba; Michael J Pencina; Ilona Kowalik; Ewa Komar; Grzegorz Opolski; Maciej Banach; Renata Główczyńska; Dominika Szalewska; Sławomir Pluta; Robert Irzmański; Zbigniew Kalarus; Ewa Piotrowicz Journal: Arch Med Sci Date: 2021-05-22 Impact factor: 3.318