Cardiovascular rehabilitation with a WCD
Authors: Rohrer U , Reischl A , Manninger M , Ebner C , Moertl D , Keller H , Dirninger A , Stix G , Alber H , Steinwender C , Binder R , Stuehlinger M , Zirlik A , Scherr D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): ZOLL

Background
The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Exercise training and rehabilitation has an IA recommendation in these patients. There are no data on safety and outcomes of patients with a WCD undergoing cardiac rehabilitation.

Purpose
The aim of this study is to evaluate the safety and feasibility of wearing a WCD while undergoing a cardiac rehabilitation program.

Methods
We performed a retrospective analysis of all patients with a successfully completed stationary rehabilitation program.

Results
55/896 patients (6.1%) registered in the Austrian WCD registry completed a stationary rehab program (60±11 years, 1% female). Underlying cardiac disease was ischaemic cardiomyopathy (CMP) in 27/55 (49%), dilatative CMP in 15/55 (27%), inflammatory CMP in 10/55 (18%) patients. One patient had valvular CMP, one patient had tako tsubo CMP, one patient had a primary electrical disease (each 1,8%). The baseline LVEF at rehab start was 36% [12;80%], duration of rehab was 28 days [18;42] compared to a total prescription duration of 94 days [26;294]. 75.6% (41/55) patients completed a regular rehab duration with a WCD, 3.6% (2/55) got their WCD stopped during rehab due to recovery of the LV function, 21,8% (12/55) got a WCD prescribed during rehab. The daily wearing duration was 23.4h [12.6;23.9].
2848 (mean 52±117/patient) automatic alarms and 340 (mean 6±9/patient) manual alarms were generated. Within this cohort 3,6% (2/55) patients had shocks for VT/VF during prescription: one patient for a VF event that was terminated with the first shock, another patient had three VT events that were also terminate with the first WCD shock. All events happened before rehabilitation, so no patient had a WCD treatment during rehab, neither appropriate, nor inappropriate. Two patient had recurrent stable VTs that were controlled with antiarrhythmic drugs during prescription, only one of them during rehab.
3 patients had a reported syncope during rehab, all of them associated with hypotension, one patient had an ambulatory check-up at the CIED clinic because of false automatic alarms due to artefacts. Following a relevant weight loss through rehab measurements, the fabric garment of the WCD had a poor fit and was adapted.
The LVEF after rehab was 42% [23;73%]. At the end of WCD prescription 33/55 (60%) had a restitution of their cardiac function with no need for an ICD, 19/55 (35%) patients were implanted with an ICD. One patient (1,8%) had a heart transplantation, one patient (1,8%) had the desire to stop WCD prescription and one patient (1,8%) had a terminal non-cardiac disease.

Conclusion
Completing a cardiovascular rehabilitation program is feasible and safe for patients prescribed with a WCD and may contribute positively to the restitution of the cardiac function.