Piccini Jonathan P, Hellkamp Anne S, Whellan David J, Ellis Stephen J, Keteyian Steven J, Kraus William E, Hernandez Adrian F, Daubert James P, Piña leana L, O'Connor Christopher M
JACC Heart Fail. 2013 Apr;1(2):142-8. doi: 10.1016/j.jchf.2013.01.005.
The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF).
Few data are available regarding the safety of exercise training in patients with ICDs and HF.
HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks.
We identified 1,053 patients (45%) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24%. Over a median of 2.2 years of follow-up, 20% (n = 108) of the exercise patients had a shock versus 22% (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95% CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95% CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95% CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95% CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95% CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95% CI: 0.86 to 1.14], p = 0.90).
We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)
本研究旨在确定运动训练是否与心力衰竭（HF）患者植入式心律转复除颤器（ICD）治疗风险增加相关。
关于ICD和HF患者运动训练安全性的数据较少。
心力衰竭和运动训练对预后影响的对照试验（HF-ACTION）将2331例射血分数（EF）≤35%的HF门诊患者随机分为运动训练组或常规治疗组。采用Cox比例风险模型来检验运动训练与ICD电击之间的关系。
我们确定了1053例基线时植入ICD的患者，他们被随机分配到运动训练组（n = 546）或常规治疗组（n = 507）。中位年龄为61岁，中位EF为24%。在中位2.2年的随访中，运动组20%（n = 108）的患者发生电击，而对照组为22%（n = 113）。持续性室性心动过速/心室颤动病史（风险比[HR]：1.93[95%置信区间（CI）：1.47至2.54]）、既往心房颤动/心房扑动（HR：1.63[95%CI：1.22至2.18]）、运动诱发的心律失常（HR：1.67[95%CI：1.23至2.26]）、较低的舒张压（每降低5 mmHg且<60时的HR：1.35[95%CI：1.12至1.61]）以及非白人种族（HR：1.50[95%CI：1.13至2.00]）与ICD电击风险增加相关。运动训练与ICD电击的发生无关（HR：0.90[95%CI：0.69至1.18]，p = 0.45）。ICD的存在与死亡或住院的主要疗效复合终点无关（HR：0.99[95%CI：0.86至1.14]，p = 0.90）。
我们没有发现接受运动训练的HF且左心室功能降低患者ICD电击增加的证据。对于患有HF的ICD植入者不应禁止运动治疗。（改善充血性心力衰竭患者临床结局的运动训练项目；NCT00047437）
