Internationale Zeitschrift für Physikalische Medizin und Rehabilitation

Internationale Zeitschrift für Physikalische Medizin und Rehabilitation
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ISSN: 2329-9096


Safety Aspects of Implantable Cardioverter Defibrillators in Patients Participating in Exercise Therapy: A Systematic Review and Meta-Analysis

Ravi R Bajaj, Aviroop Biswas, Sheldon M Singh, Paul I Oh and David A Alter

Background: The safety of exercise therapy (ET) in patients with an implantable cardioverter defibrillator (ICD) remains unclear. We sought to explore the current state of evidence and conduct a systematic review on the safety of ICDs during ET.

Methods: A systematic review was performed using CINAHL, Cochrane Library, EMBASE, Google Scholar, MEDLINE, PubMed (excluding Medline records), and Web of Science databases searched through April 2015. Studies that quantitively assessed adverse events during ET and after ET in ICD patients compared to one of two control groups (non-ICD ET or non-ET ICD patients) were included. The primary outcome was adverse events during ET. Secondary outcomes were events during ET and follow-up.

Results: Meta-analyses were performed on ten eligible studies. During ET, ICD patients experienced an increased risk of adverse events [relative risk (RR)=2.63, 95% confidence interval (CI) (1.71-4.05), P=0.01] compared to non-ICD controls. There was no significant increase risk of adverse events compared to non-ET ICD controls [RR=0.99, 95% CI (0.11-8.95), P=0.99]. ET-ICD patients had fewer adverse events during follow-up compared to non-ET ICD populations [RR=0.90, 95% CI (0.82- 0.99), P=0.02]. A sensitivity analysis including only randomized trials showed similar findings showed no difference in the primary outcome.

Conclusions: Our analysis showed increased adverse event during exercise in ICD patients as compared with non-ICD patients. Comparative adverse event rates between exercising and sedentary ICD patients were similar during ET and lower after ET, suggesting that exercise can be safe and potentially protective among ICD patients. More rigorous data from larger randomized trials is needed to further quantify the incremental risk of exercise in high-risk ICD populations.