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

• Published in: Archives of medical science Vol. 18; no. 2; pp. 293 - 306
• Main Authors: Orzechowski, Piotr, Piotrowicz, Ryszard, Zareba, Wojciech, Pencina, Michael J, Kowalik, Ilona, Komar, Ewa, Opolski, Grzegorz, Banach, Maciej, Główczyńska, Renata, Szalewska, Dominika, Pluta, Sławomir, Irzmański, Robert, Kalarus, Zbigniew, Piotrowicz, Ewa
• Format: Journal Article
• Language: English
• Published: Poland Termedia Publishing House 2022
• Subjects: Clinical Research; heart failure; telerehabilitation; ventricular arrhythmia; ventricular arrhythmia; heart failure; telerehabilitation
• ISSN: 1734-1922; 1896-9151
• DOI: 10.5114/aoms/136563

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. 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 (pVO ) as a result of comparing pVO from the beginning and the end of the program. 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 ( = 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 = 0.410). Functional response for HCTR in ΔpVO > 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 ( < 0.001). 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.