Abstract
Objective
To assess the safety and efficacy of an early home-based walking program for first-time
implantable cardioverter-defibrillator (ICD) recipients.
Design
Pre-post intervention trial.
Setting
Institutional and private practice.
Participants
Cardiac patients (N=301) with an initial ICD implantation for primary or secondary
prevention; able to read, speak, and write English; and having access to telephone.
Interventions
Early home-based walking protocol implemented 1-month post-ICD implant. Exercise tolerance
monitored by study nurses via telephone.
Main Outcome Measures
Safety assessment was based on the frequency of ICD therapies and hospitalizations, and
efficacy assessment was based on pedometer measures and self-report of ICD self-efficacy and
physical activity.
Results
ICD recipients were on average 64.1±11.9 years old, predominantly men, and white,
with an ejection fraction of <35% and a mean Charlson comorbidity score of 2.3±1.5.
Nineteen individuals (6.3%) received 28 ICD shocks; 15 (53.6%) were appropriate and
13 (46.4%) inappropriate. Antitachycardia pacing therapies were delivered 72 times
in 18 individuals (6%), with 61 (84.7%) being appropriate and 11 (15.3%) inappropriate.
Five ICD shocks (2 appropriate and 3 inappropriate) and 2 antitachycardia pacing therapies
occurred during walking. Five participants (2%) were hospitalized for an ICD shock,
none of which was associated with walking. Average steps per day increased by 806
over 3 months. Perceived exercise self-efficacy improved significantly as did weekly
exercise. Predictors of receiving any ICD shock were younger age (P<.0001), moderate to severe renal disease (P=.001), and lymphoma (P=.024).
Conclusions
Early ambulation after an initial ICD was safe and effective, with few ICD shocks
and improved efficacy.
Keywords
List of abbreviations:
ATP (antitachycardia pacing), HF (heart failure), ICD (implantable cardioverter-defibrillator), SCA (sudden cardiac arrest), SVT (supraventricular tachycardia)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 29, 2016
Footnotes
Supported by the National Institutes of Health (grant no. R01 HL 086580).
Clinical Trial Registration No.: NCT01252615.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
