Takeda Tomonori, Tsubaki Atsuhiro, Ikeda Yoshifumi, Kato Ritsushi, Kojima Sho, Makita Shigeru
Department of Rehabilitation Saitama Medical University International Medical Center Saitama Japan.
Graduate School of Niigata University of Health and Welfare Niigata Japan.
J Arrhythm. 2023 Jun 15;39(4):586-595. doi: 10.1002/joa3.12884. eCollection 2023 Aug.
The upper extremity siding cardiac implantable electrical device tends to have a limited range of motion during the perioperative period; however, the underlying reason lacks scientific evidence. This study aimed to investigate the safety of the two methods (stepwise or early) of postoperative early upper extremity rehabilitation.
We retrospectively investigated 650 consecutive patients with a new implantable pacemaker (PM), implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), or generator exchange between March 2017 and December 2020.The limitation program was conducted from March 2017 to March 2018. The intervention program started as a stepwise protocol in April 2018 and was switched to an early protocol in December 2019.
This study analyzed 591 patients, excluding 59 who met the exclusion criteria. The mean age was 76.0 (69.0-82.0) years; 412 (69.7%) patients had a PM, 79 (13.4%) had an ICD, and 100 (16.9%) utilized CRT. There were 155 patients in the limitation protocol, 251 in the stepwise protocol, and 185 patients in the early protocol groups. Postoperative complications occurred in 53 (9.0%) patients. There was no significant difference in the incidence of all complications between the three groups (16 patients [10.3%] vs. 26 patients [10.4%] vs. 11 patients [5.9%]). Shoulder exercise-related complications were defined as hematoma ( = .94), lead dislodgement ( = .16), and increased pacing threshold ( = .23). General complications included wound infection ( = .51), pneumothorax ( = .27), tamponade ( = .07), and deep venous thrombosis ( = .26).
Raising of the upper extremity siding cardiac implantable electrical devices above the head did not compromise postoperative safety.
上肢侧位植入心脏植入式电子装置在围手术期的活动范围往往有限；然而，其潜在原因缺乏科学依据。本研究旨在探讨术后早期上肢康复的两种方法（逐步或早期）的安全性。
我们回顾性研究了2017年3月至2020年12月期间连续的650例新植入起搏器（PM）、植入式心脏复律除颤器（ICD）、心脏再同步治疗（CRT）或发生器更换患者。限制方案于2017年3月至2018年3月实施。干预方案于2018年4月开始采用逐步方案，并于2019年12月改为早期方案。
本研究分析了591例患者，排除了59例符合排除标准的患者。平均年龄为76.0（69.0 - 82.0）岁；412例（69.7%）患者植入PM，79例（13.4%）植入ICD，100例（16.9%）采用CRT。限制方案组有155例患者，逐步方案组有251例，早期方案组有185例患者。53例（9.0%）患者发生术后并发症。三组间所有并发症的发生率无显著差异（16例[10.3%]对26例[10.4%]对11例[5.9%]）。与肩部运动相关的并发症定义为血肿（=0.94）、导线脱位（=0.16）和起搏阈值升高（=0.23）。一般并发症包括伤口感染（=0.51）、气胸（=0.27）、心包填塞（=0.07）和深静脉血栓形成（=0.26）。
将上肢侧位心脏植入式电子装置举过头顶不会影响术后安全性。
