On January 26, 2021, the European Journal of Preventive Cardiology published a consensus document developed jointly by the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC) and the European Heart Rhythm Association (EHRA), reflecting current views on cardiac rehabilitation in patients with cardiac implantable electronic devices (CIEDs).
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with CIEDs live worldwide and their numbers are progressively increasing. These patients should receive special attention, as their needs may differ from other patients participating in CR.
As the basis for exercise advice and prescription, a symptom-limited exercise test, preferably CPET, is mandatory. Endurance training intensity zones can be determined on the ventilatory thresholds, peak VO2, or, in absence of a CPET, on HR and HR reserve. Both the patient and the CR team need to be aware of device settings, especially the rate cut-off for therapy in patients with a defibrillator. Patients should be instructed to keep the HR at least 10–20 b.p.m. below the rate cut-off during exercise.
Psychosocial management is one of the core components of secondary prevention and CR, and psychosocial risk factors are very important for CIED recipients, particularly for those with an ICD. CBT may be an effective tool in managing stress and symptoms related to anxiety and depression.
This clinical consensus document is expected to improve the implementation of adequate comprehensive CR in patients with CIEDs, fulfilling a previous gap in recommendations and providing treatment optimization of these patients.
https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaa121/6119672
