В обзорной статье обсуждаются принципы и подходы к медицинской реабилитации пациентов с имплантированным электрокардиостимулятором (ЭКС). Показано, что кумулятивный терапевтический эффект реабилитации у пациентов с ЭКС складывается из положительного влияния медикаментозной, физической и психологической реабилитации, а также определяется потенцированием их эффективности за счет оптимизации режима и параметров электростимуляции. Для успешной социальной адаптации пациентов важно учесть специфику трудовой реабилитации, которая исключает воздействие внешних электромагнитных полей на ЭКС, что чревато его отключением (ингибицией), представляющим угрозу для жизни самих пациентов и окружающего персонала. Одним из важных аспектов жизнедеятельности пациентов с имплантированным ЭКС является определение показаний и выполнение лечебно-диагностических процедур, в том числе физиотерапевтических методов, потенциально вызывающих электромагнитную интерференцию ЭКС. Неуклонный рост частоты имплантации ЭКС во всем мире диктует необходимость организации комплексной медицинской реабилитации, способствующей улучшению качества жизни и увеличению выживаемости пациентов.
In the following review article, the principles and approaches of medical rehabilitation in patients with implanted pacemakers are discussed. It was shown that total benefit results from cooperation among medical, physical and psychological components of rehabilitation program and optimisation of the mode and parameters of cardiac pacing. Social adaptation of the patients with implantable pacemakers is of paramount importance and should be directed on avoidance of external electromagnetic fields and their influence on pacemaker functions, which in turn may be life-threatening for patient and the staff as well. The indications to diagnostic and treatment regimens including physiotherapeutic procedures should be clearly defined in order to avoid potential influence of electromagnetic interference on cardiac pacemaker. The well-structured medical rehabilitation programs need to be organised in order to improve quality of life and patient′s survival with regard to growing tendency of implantation of cardiac pacemakers.
1. Proclemer A, Zecchin M, D'Onofrio A et al. The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing – Annual report 2017. G Ital Cardiol 2019; 20 (3): 136–48. DOI: 10.1714/3108.30963
2. Steinwender C, Lercher P, Schukro C et al. State of the art: leadless ventricular pacing: A national expert consensus of the Austrian Society of Cardiology. J Interv Card Electrophysiol 2020; 57 (1): 27–37. DOI: 10.1007/s10840-019-00680-2
3. Бокерия Л.А., Ревишвили А.Ш., Дубровский И.А. Состояние электрокардиостимуляции в России в 2011 году. Вестн. аритмологии. 2013; 73: 75−9.
[Bokeriya L.A., Revishvili A.Sh., Dubrovsky I.A. Cardiac pacing in Russia in 2011. Vestn. aritmologii. 2013; 73: 75−9 (in Russian).]
4. Jankelson L, Bordachar P, Strik M et al. Reducing right ventricular pacing burden: algorithms, benefits, and risks. Europace 2019; 21 (4): 539–47. DOI: 10.1093/europace/euy263
5. Lim WY, Prabhu S, Schilling RJ. Implantable cardiac electronic devices in the elderly population. Arrhythm Electrophysiol Rev 2019; 8 (2): 143–6. DOI: 10.15420/aer.2019.3.4
6. Steffen MM, Osborn JS, Cutler MJ. Cardiac implantable electronic device therapy: permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization devices. Med Clin North Am 2019; 103 (5): 931–43. DOI: 10.1016/j.mcna.2019.04.005
7. De Vries LM, Dijk WA, Hooijschuur CA et al. Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry. Neth Heart J 2017; 25 (1): 47–55. DOI: 10.1007/s12471-016-0880-0
8. Ревишвили А.Ш., Ломидзе Н.Н., Сунгатов Р.Ш., Хасанов И.Ш. Удаленная диагностика и интеграция медицинских данных для повышения эффективности электрокардиотерапии. Вестн. аритмологии. 2016; 85: 5–18.
[Revishvili A.Sh., Lomidze N.N., Sungatov R.Sh., Khasanov I.Sh. Remote diagnosis and integration of medical data for improve efficiency of electrocardiotherapy. Vestn. aritmologii. 2016; 85: 5–18 (in Russian).]
9. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств. М., 2017; с. 156–76.
[Clinical recommendations for electrophysiological studies, catheter ablation and implantable antiarrhythmic devices. Moscow, 2017; p. 156–76 (in Russian)].
10. Татарченко И.П., Искендеров Б.Г. Некоторые аспекты лечебной реабилитации больных с искусственным водителем ритма сердца. Терапевтический архив. 1998; 8: 60–3.
[Tatarchenko I.P., Iskenderov B.G. Some aspects of therapeutic rehabilitation of patients with cardiac pacemakers. Therapeutic Archive. 1998; 8: 60–3 (in Russian)].
11. Paton MF, Gierula J, Jamil HA et al. Optimising pacemaker therapy and medical therapy in pacemaker patients for heart failure: protocol for the OPT-PACE randomised controlled trial. BMJ Open 2019; 9: e028613. DOI: 10.1136/bmjopen-2018-028613
12. HajKheder S, Haase-Fielitz A, Butter C. Cardiac implantable electronic devices and health-related quality of life. Herzschrittmacherther Elektrophysiol 2019; 30 (2): 160–7. DOI: 10.1007/s00399-019-0619-x
13. De Bardi S, Lorenzoni G, Gregon D. Social support to elderly pacemaker patients improves device acceptance and quality of life. Eur Geriatric Medicine 2016; 7 (2): 149–56. DOI: 10.1016/j.eurger.2016.02.001
14. Колпаков Е.В. Отдаленные перспективы имплантации кардиостимуляторов. Мед. альманах. 2017; 48 (3): 104–11.
[Kolpakov E.V. Long-term prospects for the implantation of pacemakers. Med. al'manakh. 2017; 48 (3): 104–11 (in Russian)].
15. Figueroa C, Alcocer L, Ramos B. Psychological intervention to modify anxiety, depression and quality of life in patients with an implantable pacemaker. Psychology 2016; 7 (03): 374–81. DOI: 10.4236/psych.2016.73040
16. Искендеров Б.Г., Петрова Е.В., Максимов Д.Б., Каменева О.А. Коморбидные тревожные расстройства и качество жизни у больных с искусственным водителем ритма. Терапевтический архив. 2011; 10: 54–8.
[Iskenderov B.G., Petrova E.V., Maksimov D.B., Kameneva O.A. Comorbid anxiety disorders and quality of life in patients with an artificial cardiac pacemaker. Therapeutic Archive. 2011; 10: 54–8 (in Russian).]
17. Iliou MC, Blanchard JC, Lamar-Tanguy A et al. Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators. Monaldi Arch Chest Dis 2016; 86 (1–2): 756. DOI: 10.4081/monaldi.2016.756
18. Calvagna GM, Patane S. Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2015; 178: 168–70. DOI: 10.1016/j.ijcard.2014.10.145
19. Hansen D, Dendale P, Coninx K et al. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol 2017; 24 (10): 1017–31. DOI: 10.1177/2047487317702042
20. Lopez-Villegas A, Catalan-Matamoros D, Robles-Musso E et al. Effectiveness of pacemaker tele-monitoring on quality of life, functional capacity, event detection and workload: The PONIENTE trial. Geriatr Gerontol Int 2016; 16 (11): 1188–95. DOI: 10.1111/ggi.12612
21. Zeitler EP, Piccini JP. Remote monitoring of cardiac implantable electronic devices. Trends Cardiovasc Med 2016; 26 (6): 568–77. DOI: 10.1016/j.tcm.2016.03.012
22. Abudan AA, Isath A, Ryan JD et al. Safety and compatibility of smart device heart rhythm monitoring in patients with cardiovascular implantable electronic devices. J Cardiovasc Electrophysiol 2019; 30 (9): 1602–9. DOI: 10.1111/jce.14024
23. Comoretto RI, Facchin D, Ghidina M et al. Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up. J Eval Clin Pract 2017; 23 (4): 681–9. DOI: 10.1111/jep.12691
24. Polikandrioti M, Tzirogiannis K, Zyga S et al. Effect of anxiety and depression on the fatigue of patients with a permanent pacemaker. Arch Med Sci Atheroscler Dis 2018; 3: e8-e17. DOI: 10.5114/amsad.2018.73231
25. Nascimento LL, Jardim TV, Sa L et al. Cardiac rehabilitation effects on functional capacity of patients with artificial cardiac pacemakers: a randomized clinical trial. Eur Heart J 2018; 39 (Suppl. 1): ehy565.P2560. DOI: 10.1093/eurheartj/ ehy565.P2560
26. Das A, Kahali D. Physiological cardiac pacing: current status. Indian Heart J 2016; 68 (4): 552−8. DOI: 10.1016/j.ihj.2016.03.033
27. Alswyan AH, Liberato ACS, Dougherty CM. A systematic review of exercise training in patients with cardiac implantable devices.
J Cardiopulm Rehabil Prev 2018; 38 (2): 70–84. DOI: 10.1097/HCR.0000000000000289
28. Caloian B, Sitar-Taut AV, Gusetu GN et al. The influence of cardiac pacemaker programming modes on exercise capacity. In Vivo 2018; 32 (2): 419–24. DOI: 10.21873/invivo.11256
29. Zeitler EP, MD, Piccini JP, Hellkamp AS et al. Exercise training and pacing status in patients with heart failure: Results from HF-ACTION. J Card Fail 2015; 21 (1): 60–7. DOI: 10.1016/j.cardfail.2014.10.004
30. Palmisano P, Aspromonte V, Ammendola E et al. Effect of fixed-rate vs. rate-responsive pacing on exercise capacity in patients with permanent, refractory atrial fibrillation and left ventricular dysfunction treated with atrioventricular junction ablation and biventricular pacing (RESPONSIBLE): a prospective, multicentre, randomized, single-blind study. Europace 2017; 19 (3): 414–20. DOI: 10.1093/europace/euw035
31. Cao Y, Zhang Y, Su Y et al. Assessment of adaptive rate response provided by accelerometer, minute ventilation and dual sensor compared with normal sinus rhythm during exercise: a self-controlled study in chronotropically competent subjects. Chin Med J 2015; 128 (1): 25–31. DOI: 10.4103/0366 6999.147798
32. Napp A, Stunder D, Ma M et al. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment? Eur Heart J 2015; 36: 1798–804. DOI: 10.1093/eurheartj/ehv135
33. Czermak T, Fichtner S. Cardiac implantable electronic devices: electromagnetic interference from electrocauterization, lithotripsy and physiotherapy. Herzschrittmacherther Elektrophysiol 2019; 30 (2): 168–76. DOI: 10.1007/s00399-019-0620-4
34. Driessen S, Napp A, Schmiedchen K et al. Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review. Europace 2019; 21 (2): 219–29. DOI: 10.1093/europace/euy155
35. Badger J, Taylor P, Swain I. The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review. J Rehabil Assist Technol Eng 2017; 4: 1–9. DOI: 10.1177/2055668317745498
36. Ghojazadeh M, Azami-Aghdash S, Sohrab-Navi Z et al. Cardiovascular patients' experiences of living with pacemaker: qualitative study. ARYA Atheroscler 2015; 11 (5): 281–8.
37. Yildiz BS, Findikoglu G, Alihanoglu YI et al. How do patients understand safety for cardiac implantable devices? Importance of postintervention education. Rehabil Res Pract 2018. Article ID 5689353. DOI: 10.1155/2018/5689353
38. Ribatti V, Santini L, Forleo GB et al. Electromagnetic interference in the current era of cardiac implantable electronic devices designed for magnetic resonance environment. G Ital Cardiol 2017; 18 (4): 295–304. DOI: 10.1714/2683.27472
39. Egger F, Hofer C, Hammerle FP et al. Influence of electrical stimulation therapy on permanent pacemaker function. Wien Klin Wochenschr 2019; 131 (13–14): 313–20. DOI: 10.1007/s00508-019-1494-5
40. Catalan-Matamoros D, Lopez-Villegas A, Tore-Lappegard K et al. Patients' experiences of remote communication after pacemaker implant: The NORDLAND study. PLoS One 2019; 14 (6): e0218521. DOI: 10.1371/journal.pone.0218521
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1. Proclemer A, Zecchin M, D'Onofrio A et al. The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing – Annual report 2017. G Ital Cardiol 2019; 20 (3): 136–48. DOI: 10.1714/3108.30963
2. Steinwender C, Lercher P, Schukro C et al. State of the art: leadless ventricular pacing: A national expert consensus of the Austrian Society of Cardiology. J Interv Card Electrophysiol 2020; 57 (1): 27–37. DOI: 10.1007/s10840-019-00680-2
3. Bokeriya L.A., Revishvili A.Sh., Dubrovsky I.A. Cardiac pacing in Russia in 2011. Vestn. aritmologii. 2013; 73: 75−9 (in Russian).
4. Jankelson L, Bordachar P, Strik M et al. Reducing right ventricular pacing burden: algorithms, benefits, and risks. Europace 2019; 21 (4): 539–47. DOI: 10.1093/europace/euy263
5. Lim WY, Prabhu S, Schilling RJ. Implantable cardiac electronic devices in the elderly population. Arrhythm Electrophysiol Rev 2019; 8 (2): 143–6. DOI: 10.15420/aer.2019.3.4
6. Steffen MM, Osborn JS, Cutler MJ. Cardiac implantable electronic device therapy: permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization devices. Med Clin North Am 2019; 103 (5): 931–43. DOI: 10.1016/j.mcna.2019.04.005
7. De Vries LM, Dijk WA, Hooijschuur CA et al. Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry. Neth Heart J 2017; 25 (1): 47–55. DOI: 10.1007/s12471-016-0880-0
8. Revishvili A.Sh., Lomidze N.N., Sungatov R.Sh., Khasanov I.Sh. Remote diagnosis and integration of medical data for improve efficiency of electrocardiotherapy. Vestn. aritmologii. 2016; 85: 5–18 (in Russian).
9. Clinical recommendations for electrophysiological studies, catheter ablation and implantable antiarrhythmic devices. Moscow, 2017; p. 156–76 (in Russian)
10. Tatarchenko I.P., Iskenderov B.G. Some aspects of therapeutic rehabilitation of patients with cardiac pacemakers. Therapeutic Archive. 1998; 8: 60–3 (in Russian)
11. Paton MF, Gierula J, Jamil HA et al. Optimising pacemaker therapy and medical therapy in pacemaker patients for heart failure: protocol for the OPT-PACE randomised controlled trial. BMJ Open 2019; 9: e028613. DOI: 10.1136/bmjopen-2018-028613
12. HajKheder S, Haase-Fielitz A, Butter C. Cardiac implantable electronic devices and health-related quality of life. Herzschrittmacherther Elektrophysiol 2019; 30 (2): 160–7. DOI: 10.1007/s00399-019-0619-x
13. De Bardi S, Lorenzoni G, Gregon D. Social support to elderly pacemaker patients improves device acceptance and quality of life. Eur Geriatric Medicine 2016; 7 (2): 149–56. DOI: 10.1016/j.eurger.2016.02.001
14. Kolpakov E.V. Long-term prospects for the implantation of pacemakers. Med. al'manakh. 2017; 48 (3): 104–11 (in Russian)
15. Figueroa C, Alcocer L, Ramos B. Psychological intervention to modify anxiety, depression and quality of life in patients with an implantable pacemaker. Psychology 2016; 7 (03): 374–81. DOI: 10.4236/psych.2016.73040
16. Iskenderov B.G., Petrova E.V., Maksimov D.B., Kameneva O.A. Comorbid anxiety disorders and quality of life in patients with an artificial cardiac pacemaker. Therapeutic Archive. 2011; 10: 54–8 (in Russian).
17. Iliou MC, Blanchard JC, Lamar-Tanguy A et al. Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators. Monaldi Arch Chest Dis 2016; 86 (1–2): 756. DOI: 10.4081/monaldi.2016.756
18. Calvagna GM, Patane S. Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2015; 178: 168–70. DOI: 10.1016/j.ijcard.2014.10.145
19. Hansen D, Dendale P, Coninx K et al. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol 2017; 24 (10): 1017–31. DOI: 10.1177/2047487317702042
20. Lopez-Villegas A, Catalan-Matamoros D, Robles-Musso E et al. Effectiveness of pacemaker tele-monitoring on quality of life, functional capacity, event detection and workload: The PONIENTE trial. Geriatr Gerontol Int 2016; 16 (11): 1188–95. DOI: 10.1111/ggi.12612
21. Zeitler EP, Piccini JP. Remote monitoring of cardiac implantable electronic devices. Trends Cardiovasc Med 2016; 26 (6): 568–77. DOI: 10.1016/j.tcm.2016.03.012
22. Abudan AA, Isath A, Ryan JD et al. Safety and compatibility of smart device heart rhythm monitoring in patients with cardiovascular implantable electronic devices. J Cardiovasc Electrophysiol 2019; 30 (9): 1602–9. DOI: 10.1111/jce.14024
23. Comoretto RI, Facchin D, Ghidina M et al. Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up. J Eval Clin Pract 2017; 23 (4): 681–9. DOI: 10.1111/jep.12691
24. Polikandrioti M, Tzirogiannis K, Zyga S et al. Effect of anxiety and depression on the fatigue of patients with a permanent pacemaker. Arch Med Sci Atheroscler Dis 2018; 3: e8-e17. DOI: 10.5114/amsad.2018.73231
25. Nascimento LL, Jardim TV, Sa L et al. Cardiac rehabilitation effects on functional capacity of patients with artificial cardiac pacemakers: a randomized clinical trial. Eur Heart J 2018; 39 (Suppl. 1): ehy565.P2560. DOI: 10.1093/eurheartj/ ehy565.P2560
26. Das A, Kahali D. Physiological cardiac pacing: current status. Indian Heart J 2016; 68 (4): 552−8. DOI: 10.1016/j.ihj.2016.03.033
27. Alswyan AH, Liberato ACS, Dougherty CM. A systematic review of exercise training in patients with cardiac implantable devices.
J Cardiopulm Rehabil Prev 2018; 38 (2): 70–84. DOI: 10.1097/HCR.0000000000000289
28. Caloian B, Sitar-Taut AV, Gusetu GN et al. The influence of cardiac pacemaker programming modes on exercise capacity. In Vivo 2018; 32 (2): 419–24. DOI: 10.21873/invivo.11256
29. Zeitler EP, MD, Piccini JP, Hellkamp AS et al. Exercise training and pacing status in patients with heart failure: Results from HF-ACTION. J Card Fail 2015; 21 (1): 60–7. DOI: 10.1016/j.cardfail.2014.10.004
30. Palmisano P, Aspromonte V, Ammendola E et al. Effect of fixed-rate vs. rate-responsive pacing on exercise capacity in patients with permanent, refractory atrial fibrillation and left ventricular dysfunction treated with atrioventricular junction ablation and biventricular pacing (RESPONSIBLE): a prospective, multicentre, randomized, single-blind study. Europace 2017; 19 (3): 414–20. DOI: 10.1093/europace/euw035
31. Cao Y, Zhang Y, Su Y et al. Assessment of adaptive rate response provided by accelerometer, minute ventilation and dual sensor compared with normal sinus rhythm during exercise: a self-controlled study in chronotropically competent subjects. Chin Med J 2015; 128 (1): 25–31. DOI: 10.4103/0366 6999.147798
32. Napp A, Stunder D, Ma M et al. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment? Eur Heart J 2015; 36: 1798–804. DOI: 10.1093/eurheartj/ehv135
33. Czermak T, Fichtner S. Cardiac implantable electronic devices: electromagnetic interference from electrocauterization, lithotripsy and physiotherapy. Herzschrittmacherther Elektrophysiol 2019; 30 (2): 168–76. DOI: 10.1007/s00399-019-0620-4
34. Driessen S, Napp A, Schmiedchen K et al. Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review. Europace 2019; 21 (2): 219–29. DOI: 10.1093/europace/euy155
35. Badger J, Taylor P, Swain I. The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review. J Rehabil Assist Technol Eng 2017; 4: 1–9. DOI: 10.1177/2055668317745498
36. Ghojazadeh M, Azami-Aghdash S, Sohrab-Navi Z et al. Cardiovascular patients' experiences of living with pacemaker: qualitative study. ARYA Atheroscler 2015; 11 (5): 281–8.
37. Yildiz BS, Findikoglu G, Alihanoglu YI et al. How do patients understand safety for cardiac implantable devices? Importance of postintervention education. Rehabil Res Pract 2018. Article ID 5689353. DOI: 10.1155/2018/5689353
38. Ribatti V, Santini L, Forleo GB et al. Electromagnetic interference in the current era of cardiac implantable electronic devices designed for magnetic resonance environment. G Ital Cardiol 2017; 18 (4): 295–304. DOI: 10.1714/2683.27472
39. Egger F, Hofer C, Hammerle FP et al. Influence of electrical stimulation therapy on permanent pacemaker function. Wien Klin Wochenschr 2019; 131 (13–14): 313–20. DOI: 10.1007/s00508-019-1494-5
40. Catalan-Matamoros D, Lopez-Villegas A, Tore-Lappegard K et al. Patients' experiences of remote communication after pacemaker implant: The NORDLAND study. PLoS One 2019; 14 (6): e0218521. DOI: 10.1371/journal.pone.0218521
Пензенский институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Пенза, Россия
*iskenderovbg@mail.ru
________________________________________________
Bakhram G. Iskenderov*, Marina G. Ivanchukova, Natalya V. Berenshtejn
Penza Institute for Advanced Medical Education – branch Russian Medical Academy of Continuous Professional Education, Penza, Russia
*iskenderovbg@mail.ru