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. 2021 May 22;18(2):293-306.
doi: 10.5114/aoms/136563. eCollection 2022.

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up - subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial

Piotr Orzechowski  1 , Ryszard Piotrowicz  2   3 , Wojciech Zareba  4 , Michael J Pencina  5 , Ilona Kowalik  2 , Ewa Komar  6 , Grzegorz Opolski  7 , Maciej Banach  8 , Renata Główczyńska  7 , Dominika Szalewska  9 , Sławomir Pluta  10 , Robert Irzmański  11 , Zbigniew Kalarus  12 , Ewa Piotrowicz  1
Affiliations

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up - subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial

Piotr Orzechowski et al. Arch Med Sci. .

Abstract

Introduction: Cardiac rehabilitation is a component of heart failure (HF) management, but its effect on ventricular arrhythmias is not well understood. We analyzed the antiarrhythmic effect of a 9-week hybrid comprehensive telerehabilitation (HCTR) program and its influence on long-term cardiovascular mortality in HF patients taken from the TELEREHabilitation in Heart Failure Patients (TELEREH-HF) trial.

Material and methods: We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥ 10 beats/hour (PVCs ≥ 10) in 24-hour ECG monitoring at baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Functional response for HCTR was assessed by changes - delta (Δ) - in peak oxygen consumption (pVO2) as a result of comparing pVO2 from the beginning and the end of the program.

Results: Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR. Similarly, among 165 patients randomized to UC who had nsVT 34.5% did not show it after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥ 10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR in ΔpVO2 > 2.0 ml/kg/min did not affect occurrence of arrhythmias. Multivariable analysis did not identify HCTR as an independent factor determining improvement of nsVT or PVCs ≥ 10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2-year follow-up (p < 0.001).

Conclusions: Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥ 10. An antiarrhythmic effect after the 9-week HCTR affected long-term cardiovascular mortality in HF patients.

Keywords: heart failure; telerehabilitation; ventricular arrhythmia.

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Conflict of interest statement

The authors were supported by the National Centre for Research and Development, Warsaw, Poland (grant STRATEGMED/233547/13/NCBR/2015).

Figures

Figure 1
Figure 1
Study flow diagram HCTR – hybrid comprehensive telerehabilitation, UC – usual care, ECG – electrocardiography.
Figure 2
Figure 2
Kaplan-Meier plot of cardiovascular mortality by randomized treatment arm and nsVT nsVT – non-sustained ventricular tachycardia, HCTR – hybrid comprehensive telerehabilitation, UC – usual care.
See this image and copyright information in PMC

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