Low Burden of Arrhythmia in Pediatric Patients and Patients With Congenital Heart Disease Participating in Cardiac Rehabilitation

BACKGROUND: Cardiac rehabilitation (CR) is underused in pediatric and congenital heart disease populations. Concern about arrhythmia risk may be an obstacle to CR referral. We sought to describe the frequency and risk factors for arrhythmia in patients who participated in a standardized CR program. METHODS: We conducted a retrospective chart review of all patients who completed at least 1 CR encounter from 2017 to 2022 at a pediatric cardiology center. We used descriptive statistics to determine the frequency of atrial and ventricular ectopy. Logistic regression was performed to identify predictors of frequent ventricular ectopy, nonsustained ventricular tachycardia, or ventricular tachycardia. RESULTS: There were 177 patients who participated in 4494 rehabilitation encounters over the 6-year study period (median age, 17 years [14-22]). Most patients had congenital heart disease (63%). Moderate or severe systolic dysfunction was noted in 14% of patients. Presence of an implantable cardioverter-defibrillator (9% of patients) and a ventricular assist device (5% of patients) was noted. Nonsustained ventricular tachycardia occurred in 7 patients (3.9%) across 18 sessions (0.4%). There was an episode of sustained ventricular tachycardia resulting in an appropriate implantable cardioverter-defibrillator shock. There were no deaths. Patients ≥18 years old (odds ratio, 2.7 [95% CI, 1.1 - 6.4]) were more likely to have frequent ventricular ectopy, nonsustained ventricular tachycardia, or ventricular tachycardia. CONCLUSIONS: Supervised CR in pediatric and congenital heart disease populations is associated with a low risk for clinically significant arrhythmias, and should not be an obstacle to referral for individuals who would otherwise benefit from CR.