Skip to main content

Advertisement

SpringerLink
Log in

LVAD in der kardiologischen Rehabilitation

Leistungsphysiologische und rhythmologische Aspekte

Cardiac rehabilitation in LVAD patients

Aspects regarding exercise and rhythm

  • Schwerpunkt
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Nach der Implantation eines linksventrikulären Herzunterstützungssystems („left ventricular assist device“, LVAD) wird die Teilnahme an einem kardiologischen Rehabilitationsprogramm (KardReha) ausdrücklich empfohlen. Wesentliche Inhalte bilden neben vielen weiteren Bereichen insbesondere die Sport- und Bewegungstherapie sowie Aspekte der Rhythmuskontrolle. LVAD-Patienten erreichen im Verlauf in der Regel wieder eine gute Lebensqualität und zufriedenstellende funktionelle Kapazität. Die maximalen Leistungswerte blieben hingegen u. a. aufgrund der fest eingestellten Pumpenumdrehungszahl und des limitierten Herzzeitvolumens deutlich reduziert. Von besonderer Wichtigkeit ist daher ein strukturiertes und langfristiges körperliches Training – auch über den Zeitraum der KardReha Phase II hinaus – zur Optimierung der neuromuskulären Ansteuerung sowie der Stoffwechselprozesse innerhalb der Arbeitsmuskulatur. Einschränkungen in der körperlichen Leistungsfähigkeit können auch durch das Auftreten von supraventrikulären und ventrikulären Arrhythmien hervorgerufen werden. Ursächlich ist in beiden Fällen eine zunehmende hämodynamische Beeinträchtigung des rechten Herzens mit weiteren negativen hämodynamischen Konsequenzen für den vom LVAD generierten Fluss. Auch eine nicht adäquate Einstellung weiterer bereits implantierter kardialer elektronischer Geräte (z. B. implantierbarer Kardioverter-Defibrillator [ICD] oder kardiale Resynchronisationstherapie mit Defibrillator [CRT-D]) kann die Hämodynamik bei LVAD-Patienten entscheidend beeinflussen. In diesem Artikel soll im Folgenden auf leistungsphysiologische und rhythmologische Aspekte der LVAD-Therapie im Rahmen der KardReha eingegangen werden.

Abstract

After implantation of a left ventricular assist device (LVAD), it is strongly recommended that patients participate in an inpatient cardiac rehabilitation program (CR). Relevant topics during CR include sports and exercise therapy as well as aspects of cardiac rhythm control. Over time, LVAD patients usually regain a good quality of life and an adequate functional capacity can be observed. However, maximum performance values remain markedly reduced, in part due to the fixed LVAD pump speed and the limited total cardiac output. Therefore, structured long-term exercise training programs (even beyond CR phase II) are of particular importance in order to optimize neuromuscular control and muscle metabolism. Limitations to physical performance values may also be caused by the occurrence of supraventricular and/or ventricular arrhythmias. In both cases, the cause is an increasing hemodynamic impairment of the right heart, which may also lead to a reduced LVAD pump flow. In addition, inadequate setting of other cardiac implantable electronic devices (e.g., implantable cardioverter–defibrillator [ICD] or cardiac resynchronization therapy with defibrillator [CRT-D]) may also have a crucial impact on hemodynamics after LVAD implantation. In this article, we will discuss specific aspects of LVAD therapy related to exercise and rhythm control, particularly in the context of CR programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Hildebrandt A, Willemsen D, Reiss N et al (2019) Characteristics, therapeutic needs, and scope of patients with a continuous-flow left ventricular device entering cardiac rehabilitation: a retrospective analysis. J Cardiopulm Rehabil Prev 39:91–96. https://doi.org/10.1097/HCR.0000000000000342

    Article  PubMed  Google Scholar 

  2. Reiss N, Schmidt T, Langheim E et al (2021) Inpatient cardiac rehabilitation of LVAD patients-updated recommendations from the working group of the German society for prevention and rehabilitation of cardiovascular diseases. Thorac Cardiovasc Surg 69:70–82. https://doi.org/10.1055/s-0039-1691837

    Article  PubMed  Google Scholar 

  3. Willemsen D, Cordes C, Bjarnason-Wehrens B et al (2016) Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD). Clin Res Cardiol 11(1):2–49. https://doi.org/10.1007/s11789-015-0077-x

    Article  Google Scholar 

  4. Mirza KK, Gustafsson F (2020) Determinants of functional capacity and quality of life after implantation of a durable left ventricular assist device. Card Fail Rev 6:e29. https://doi.org/10.15420/cfr.2020.15

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mirza KK, Szymanski MK, Schmidt T et al (2021) Prognostic value of peak oxygen uptake in patients supported with left ventricular assist devices (PRO-VAD). JACC Heart Fail 9:758–767. https://doi.org/10.1016/j.jchf.2021.05.021

    Article  PubMed  Google Scholar 

  6. Schmidt T, Bjarnason-Wehrens B, Mommertz S et al (2019) Development of exercise-related values in heart failure patients supported with a left ventricular assist device. Int J Artif Organs 42:201–206. https://doi.org/10.1177/0391398818815492

    Article  PubMed  Google Scholar 

  7. Granegger M, Schlöglhofer T, Ober H et al (2016) Daily life activity in patients with left ventricular assist devices. Int J Artif Organs 39:22–27. https://doi.org/10.5301/ijao.5000464

    Article  PubMed  PubMed Central  Google Scholar 

  8. Khawaja T, Chokshi A, Ji R et al (2014) Ventricular assist device implantation improves skeletal muscle function, oxidative capacity, and growth hormone/insulin-like growth factor‑1 axis signaling in patients with advanced heart failure. J Cachexia Sarcopenia Muscle 5:297–305. https://doi.org/10.1007/s13539-014-0155-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Loyaga-Rendon RY, Plaisance EP, Arena R et al (2015) Exercise physiology, testing, and training in patients supported by a left ventricular assist device. J Heart Lung Transplant 34:1005–1016. https://doi.org/10.1016/j.healun.2014.12.006

    Article  PubMed  Google Scholar 

  10. Reiss N, Schmidt T, Workowski A et al (2016) Physical capacity in LVAD patients: hemodynamic principles, diagnostic tools and training control. Int J Artif Organs 39:451–459. https://doi.org/10.5301/ijao.5000529

    Article  PubMed  Google Scholar 

  11. Truby LK, Garan AR, Givens RC et al (2018) Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry. JACC Heart Fail 6:951–960. https://doi.org/10.1016/j.jchf.2018.07.012

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schmidt T, Bjarnason-Wehrens B, Schulte-Eistrup S et al (2018) Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device-an overview. J Thorac Dis 10:S1802–S1810. https://doi.org/10.21037/jtd.2018.01.114

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schmidt T, Bjarnason-Wehrens B, Mommertz S et al (2018) Changes in total cardiac output and oxygen extraction during exercise in patients supported with an HVAD left ventricular assist device. Artif Organs 42:686–694. https://doi.org/10.1111/aor.13102

    Article  CAS  PubMed  Google Scholar 

  14. AWMF (2019) S3-Leitlinie zur kardiologischen Rehabilitation (LL-KardReha) im deutschsprachigen Raum Europas, Deutschland, Österreich, Schweiz (D-A-CH) (AWMF Registernummer: 133/001)

    Google Scholar 

  15. Bachmann JM, Duncan MS, Shah AS et al (2018) Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation. JACC Heart Fail 6:130–139. https://doi.org/10.1016/j.jchf.2017.11.002

    Article  PubMed  PubMed Central  Google Scholar 

  16. Adamopoulos S, Corrà U, Laoutaris ID et al (2019) Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the committee on exercise physiology and training and the committee of advanced heart failure of the heart failure association of the European society of cardiology. Eur J Heart Fail 21:3–13. https://doi.org/10.1002/ejhf.1352

    Article  PubMed  Google Scholar 

  17. Moreno-Suarez I, Scheer A, Lam K et al (2020) High-intensity interval training in patients with left ventricular assist devices: a pilot randomized controlled trial. J Heart Lung Transplant 39:1380–1388. https://doi.org/10.1016/j.healun.2020.08.005

    Article  PubMed  Google Scholar 

  18. Ozcan C, Deshmukh A (2020) Atrial arrhythmias in patients with left ventricular assist devices. Curr Opin Cardiol 35:276–281. https://doi.org/10.1097/HCO.0000000000000729

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gopinathannair R, Cornwell WK, Dukes JW et al (2019) Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the American heart association. Circulation 139:e967–e989. https://doi.org/10.1161/CIR.0000000000000673

    Article  PubMed  Google Scholar 

  20. Hickey KT, Garan H, Mancini DM et al (2016) Atrial fibrillation in patients with left ventricular assist devices: incidence, predictors, and clinical outcomes. JACC Clin Electrophysiol 2:793–798. https://doi.org/10.1016/j.jacep.2016.03.009

    Article  PubMed  Google Scholar 

  21. Enriquez AD, Calenda B, Gandhi PU et al (2014) Clinical impact of atrial fibrillation in patients with the HeartMate II left ventricular assist device. J Am Coll Cardiol 64:1883–1890. https://doi.org/10.1016/j.jacc.2014.07.989

    Article  PubMed  Google Scholar 

  22. Gustafsson F, Shaw S, Lavee J et al (2018) Six-month outcomes after treatment of advanced heart failure with a full magnetically levitated continuous flow left ventricular assist device: report from the ELEVATE registry. Eur Heart J 39:3454–3460. https://doi.org/10.1093/eurheartj/ehy513

    Article  CAS  PubMed  Google Scholar 

  23. Deshmukh A, Kim G, Burke M et al (2017) Atrial arrhythmias and electroanatomical remodeling in patients with left ventricular assist devices. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.005340

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hawkins RB, Mehaffey JH, Guo A et al (2018) Postoperative atrial fibrillation is associated with increased morbidity and resource utilization after left ventricular assist device placement. J Thorac Cardiovasc Surg 156:1543–1549.e4. https://doi.org/10.1016/j.jtcvs.2018.03.169

    Article  PubMed  PubMed Central  Google Scholar 

  25. Noll AE, Adewumi J, Amuthan R et al (2019) Atrial tachyarrhythmias among patients with left ventricular assist devices: prevalence, clinical outcomes, and impact of rhythm control strategies. JACC Clin Electrophysiol 5:459–466. https://doi.org/10.1016/j.jacep.2018.11.016

    Article  PubMed  Google Scholar 

  26. Feldman D, Pamboukian SV, Teuteberg JJ et al (2013) The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 32:157–187. https://doi.org/10.1016/j.healun.2012.09.013

    Article  PubMed  Google Scholar 

  27. Jennings DL, Jones MC, Lanfear DE (2012) Assessment of the heart failure pharmacotherapy of patients with continuous flow left-ventricular assist devices. Int J Artif Organs 35:177–179. https://doi.org/10.5301/ijao.5000068

    Article  PubMed  Google Scholar 

  28. Chung YJ, Choi J‑O, Park K‑M (2021) Catheter ablation for atrial fibrillation in left ventricular assist device: a case report. Medicine 100:e26308. https://doi.org/10.1097/MD.0000000000026308

    Article  PubMed  PubMed Central  Google Scholar 

  29. Shi J, Yu X, Liu Z (2022) A review of new-onset ventricular arrhythmia after left ventricular assist device implantation. Cardiology 147:315–327. https://doi.org/10.1159/000524779

    Article  PubMed  Google Scholar 

  30. Langheim E, Reiss N, Cordes C et al (2017) Cardiac rehabilitation in patients with mechanical circulatory support. Dtsch Med Wochenschr 142:282–289. https://doi.org/10.1055/s-0042-103708

    Article  PubMed  Google Scholar 

  31. Alvarez PA, Sperry BW, Pérez AL et al (2019) Implantable cardioverter defibrillators in patients with continuous flow left ventricular assist devices: utilization patterns, related procedures, and complications. J Am Heart Assoc. https://doi.org/10.1161/JAHA.118.011813

    Article  PubMed  PubMed Central  Google Scholar 

  32. Refaat MM, Tanaka T, Kormos RL et al (2012) Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. J Card Fail 18:140–145. https://doi.org/10.1016/j.cardfail.2011.10.020

    Article  PubMed  Google Scholar 

  33. Kumar A, Tandon V, O’Sullivan DM et al (2019) ICD shocks in LVAD patients are not associated with increased subsequent mortality risk. J Interv Card Electrophysiol 56:341–348. https://doi.org/10.1007/s10840-019-00619-7

    Article  PubMed  Google Scholar 

  34. Chung BB, Grinstein JS, Imamura T et al (2021) Biventricular pacing versus right ventricular pacing in patients supported with LVAD. JACC Clin Electrophysiol 7:1003–1009. https://doi.org/10.1016/j.jacep.2021.01.016

    Article  PubMed  Google Scholar 

  35. Black-Maier E, Lewis RK, Rehorn M et al (2020) Implantable cardioverter-defibrillator lead revision following left ventricular assist device implantation. J Cardiovasc Electrophysiol 31:1509–1518. https://doi.org/10.1111/jce.14487

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland

    Thomas Schmidt

  2. Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Deutschland

    Thomas Schmidt & Nils Reiss

Authors
  1. Thomas Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nils Reiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Schmidt.

Ethics declarations

Interessenkonflikt

T. Schmidt und N. Reiss geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schmidt, T., Reiss, N. LVAD in der kardiologischen Rehabilitation. Herzschr Elektrophys 34, 45–51 (2023). https://doi.org/10.1007/s00399-022-00914-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-022-00914-3

Schlüsselwörter

Keywords

Search

Navigation