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; 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

doi:10.5114/aoms/136563

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

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

Authors

Affiliations

¹ Telecardiology Center, National Institute of Cardiology, Warsaw, Poland.
² National Institute of Cardiology, Warsaw, Poland.
³ College of Rehabilitation, Warsaw, Poland.
⁴ Department of Medicine, University of Rochester Medical Center, Rochester, USA.
⁵ Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA.
⁶ Military Institute of Medicine, Warsaw, Poland.
⁷ 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
⁸ Department of Hypertension, Medical University of Lodz, Lodz, Poland.
⁹ Chair and Clinic of Rehabilitation Medicine, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
¹⁰ Silesian Center for Heart Diseases, Zabrze, Poland.
¹¹ Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Lodz, Poland.
¹² Department of Cardiology, Congenital Heart Disease and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.

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.