Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators.
Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators.
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DOI：
10.4081/monaldi.2016.756
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发表时间：
2016-10-14
期刊：
影响因子：
--
通讯作者：
Ledru, Francois
中科院分区：
文献类型：
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作者：
Iliou, Marie Christine;Blanchard, Jean Christophe;Ledru, Francois
心脏康复中心收治的大部分患者都有心脏起搏器、心脏再同步（CRT）或植入式心脏除颤器（ICD）。植入式电子设备作为心脏起搏器或ICD对心力衰竭患者的心脏康复是一个独特的机会，不仅可以优化医疗，增加他们的运动能力，改善他们的临床状况，而且还可以监督设备的正确功能。CRT可减轻临床症状，并略微增加运动能力。但在这些患者中，临床改善很可能是由于装置引起的心功能增强，以及运动对周围（肌肉和血管）和心脏的影响得到改善。在这一人群中，运动带来的额外预期收益在14%到25%之间。在植入ICD的患者中，运动训练是安全的，不会增加电击或抗心动过速起搏治疗。综合心脏康复结合运动训练和心理教育干预可提高运动能力、生活质量、全身健康和心理健康。然而，需要进一步的大规模研究来评估最合适的治疗方法，并明确证明心脏康复在这一特殊患者群体中的作用。
Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity. But in these patients, the clinical improvements are likely to be explained by both the enhancement of cardiac function induced by the device and by the improved peripheral (muscular and vascular) and cardiac effects of exercise. The additional expected gain by exercise in this population is between 14 to 25%. In patients implanted with an ICD, exercise training is safe, without increasing shocks or anti-tachycardia pacing therapy. The comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves exercise capacity, quality of life, general and mental health. Nevertheless, further large scale studies was needed to evaluate the most appropriate management and demonstrate definitively the role of cardiac rehabilitation in this particular group of patients.