In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to EAPC Ivory (& above) Members, Fellows of the ESC and Young combined Members

Ventricular tachyarrhythmias reduction in heart failure by modulation of cardiac autonomic nervous system with cardiac rehabilitation

Session Poster Session I - Thursday 08:30 - 12:30

Speaker Dinis Rafael Valbom Mesquita

Congress : EuroPrevent 2015

  • Topic : preventive cardiology
  • Sub-topic : Cardiovascular Rehabilitation
  • Session type : Poster Session
  • FP Number : P100

Authors : D Mesquita (Lisbon,PT), A Abreu (Lisbon,PT), G Portugal (Lisbon,PT), S Rosa (Lisbon,PT), P Rio (Lisbon,PT), M Oliveira (Lisbon,PT), P S Cunha (Lisbon,PT), V Santos (Lisbon,PT), H Santa-Clara (Lisbon,PT), R Ferreira (Lisbon,PT)


D Mesquita1 , A Abreu1 , G Portugal1 , S Rosa1 , P Rio1 , M Oliveira1 , P S Cunha1 , V Santos2 , H Santa-Clara2 , R Ferreira1 , 1Hospital de Santa Marta - Lisbon - Portugal , 2Human Motricity Faculty, Lisbon University - Lisbon - Portugal ,


Purpose: Autonomic nervous system (ANS) dysfunction plays a central role in chronic heart failure (HF). Patients (P) with severe left ventricle (LV) systolic dysfunction have increased risk of malignant ventricular tachyarrhythmias (VT/VF). Besides the cardioverter-defibrillator (ICD) and optimal medical therapy no other strategies have shown to reduce the negative impact of VT/VF on survival. It has been suggested that cardiac rehabilitation programs can induce a positive modulation of ANS. It's uncertain whether this can be translated in clinical practice by a reduction of VT/VF. Our aim was to assess if a phase 2 cardiac rehabilitation program could reduce the occurrence of sustained VT/VF in P with chronic HF and documented ANS dysfunction.

Methods: Prospective study in a cohort of 108P submitted to cardiac resynchronization therapy (CRT), with an ICD in a primary prevention strategy. All P performed cardiac scintigraphy with 123 metaiodo-benzylguanidine in the 48h previous to CRT implant to assess cardiac ANS dysfunction. We considered cardiac ANS dysfunction parameters of Early and Late "heart to mediastinum" rate – HMR - below 1,5 or a washout rate (WR) above 30%. Afterwards, P were randomized to perform a phase 2 cardiac rehabilitation program (30 programed and surveyed sessions) or no rehabilitation. We assessed the medium (3months) to long-term (2 years) occurrence of VT/VF by the interrogation of the CRT device.

Results: There were 67,9% male, with 68,1±9,9 years, and a mean LV ejection fraction of 27±7%, with ischemic etiology in 33,3% and diabetes in 38,9%. Sixty three P (57,8%) were in class III of NYHA and 73% on beta blockers. There were no significant differences between basal characteristics of the 2 groups, namely the occurrence of cardiac ANS (early HMR: p=0,810, late HMR: p=1,0 and WR: p=1,0). The rehabilitation group had a higher rate of previous cardiac surgery (p=0,023). During a follow-up of 630,8 ± 309,7 days, 16P (14,8%) had VT/VF with appropriate treatment via ICD. The occurrence of VT/VF was higher in the cohort of P with cardiac ANS dysfunction, as assessed by the early HMR (p=0,034). P with baseline cardiac ANS dysfunction that did not underwent cardiac rehabilitation were at higher risk of VT/VF (Odds Ratio 4,38; p=0,035), whereas the occurrence of VT/VF was similar in P that completed the cardiac rehabilitation program compared to P without cardiac ANS dysfunction (p=0,597).

Conclusions: HF is associated with a high incidence of cardiac ANS dysfunction. Cardiac rehabilitation seems to modulate ANS in these population and contribute to reduce the incidence of VT/VF.

Based on your interests

Three reasons why you should become a member

Become a member now
  • 1Access your congress resources all year-round on the New ESC 365
  • 2Get a discount on your next congress registration
  • 3Continue your professional development with free access to educational tools
Become a member now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer Alliance, and Novartis Pharma AG. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are