Title 5 不整脈と循環器リハビリテーション
Subtitle 特集 新時代の循環器リハビリテーション医療のエビデンス
Authors 白石裕一*1,2, 的場聖明*1, 三上靖夫*2
Authors (kana)
Organization *1京都府立医科大学循環器腎臓内科, *2京都府立医科大学リハビリテーション部
Journal The Japanese Journal of Rehabilitation Medicine
Volume 60
Number 4
Page 304-312
Year/Month 2023 / 4
Article 報告
Publisher 日本リハビリテーション医学会
Abstract 「要旨」 循環器リハビリテーション医療は虚血性心疾患や心不全, 心臓外科術後患者で広く行われているが, 不整脈疾患に対してはまだエビデンスが十分ではない. 器質的心疾患に伴う不整脈においては, リハビリテーション治療を通じた虚血の改善や交感神経の抑制による背景疾患の改善が不整脈の改善につながる可能性が期待される. また, 頻度の多い心房細動について運動との関連に関する研究が進んできた. 心房細動の発生に生活習慣病との関連が認められ, 一次予防として高血圧や肥満の改善の他, 運動の推奨もされるようになってきた. 発作性心房細動患者に対する運動療法の効果や, アブレーション後の運動療法, 心不全を合併した例に対する運動療法の報告が蓄積されており, 本稿ではそれらの報告やガイドラインを参考にしながら解説していく.
Practice 医療技術
Keywords 不整脈, リハビリテーション医療
  • 全文ダウンロード: 従量制、基本料金制の方共に770円(税込) です。


  • 1) 日本循環器学会/日本心臓リハビリテーション学会: 2021年改訂版心血管疾患におけるリハビリテーションに関するガイドライン. Available from URL: https://www.j-circ.or.jp/cms/wp-ontent/uploads/2021/03/JCS2021_Makita.pdf
  • 2) Podrid PJ, Graboys TB, Lampert S, Blatt C: Exercise stress testing for exposure of arrhythmias. Circulation 1987; 75: III 60-68
  • 3) Voss F, Schueler M, Lauterbach M, Bauer A, Katus HA, Becker R: Safety of symptom-limited exercise testing in a big cohort of a modern ICD population. Clin Res Cardiol 2016; 105: 53-58
  • 4) Maron BJ: The paradox of exercise. N Engl J Med 2000; 343: 1409-1411
  • 5) Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE: Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000; 343: 1355-1361
  • 6) Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE: Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 1993; 329: 1677-1683
  • 7) Jouven X, Zureik M, Desnos M, Courbon D, Ducimetiere P: Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med 2000; 343: 826-833
  • 8) Laukkanen JA, Makikallio TH, Rauramaa R, Kiviniemi V, Ronkainen K, Kurl S: Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study. J Am Coll Cardiol 2010; 56: 1476-1483
  • 9) Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T: Exercise standards for testing and training; a statement for healthcare professionals from the American Heart Association. Circulation 2001; 104: 1694-1740
  • 10) Pandey A, Parashar A, Moore C, Ngo C, Salahuddin U, Bhargava M, Kumbhani DJ, Piccini JP, Fonarow GC, Berry JD: Safety and Efficacy of Exercise Training in Patients With an Implantable Cardioverter-Defibrillator: A Meta-Analysis. JACC Clin Electrophysiol 2017; 3: 117-126
  • 11) Nielsen KM, Zwisler AD, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Jakobsen JC, Berg SK: Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Cochrane Database Syst Rev 2019; 2: CD011828
  • 12) Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, White R, Furberg CD, Rautaharju PM: Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997; 96: 2455-2461
  • 13) Fauchier L, Samson A, Chaize G, Gaudin AF, Vainchtock A, Bailly C, Cotte FE: Cause of death in patients with atrial fibrillation admitted to French hospitals in 2012: a nationwide database study. Open Heart 2015; 2: e000290
  • 14) Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology(ESC)developed with the special contribution of the European Heart Rhythm Association(EHRA) of the ESC. Eur Heart J 2021; 42: 373-498
  • 15) Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ, Maclehose R, Konety S, Alonso A: Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC)study. Circulation 2011; 123: 1501-1508
  • 16) Huxley RR, Filion KB, Konety S, Alonso A: Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56-62
  • 17) Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, Seward JB, Tsang TS: Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119-125
  • 18) Zhu W, Shen Y, Zhou Q, Xu Z, Huang L, Chen Q, Hong K: Association of Physical Fitness With the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Clin Cardiol 2016; 39: 421-428
  • 19) Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JP, Finnie JW, Samuel CS, Royce SG, Twomey DJ, Thanigaimani S, Kalman JM, Sanders P: Electrophysiological, Electroanatomical, and Structural Remodeling of the Atria as Consequences of Sustained Obesity. J Am Coll Cardiol 2015; 66: 1-11
  • 20) Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Hendriks JM, Twomey D, Kalman JM, Abhayaratna WP, Lau DH, Sanders P: Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. J Am Coll Cardiol 2015; 66: 985-996
  • 21) Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P: Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study(LEGACY). J Am Coll Cardiol 2015; 65: 2159-2169
  • 22) Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, Alasady M, Hanley L, Antic NA, McEvoy RD, Kalman JM, Abhayaratna WP, Sanders P: Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol 2014; 64: 2222-2231
  • 23) Heidbuchel H, Anne W, Willems R, Adriaenssens B, Van de Werf F, Ector H: Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol 2006; 107: 67-72
  • 24) Mozaffarian D, Furberg CD, Psaty BM, Siscovick D: Physicalactivity and incidence of atrial fibrillation in older adults. Circulation 2008; 118: 800-807
  • 25) Frost L, Frost P, Vestergaard P: Work related physical activity and risk of a hospital discharge diagnosis of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Occup Environ Med 2005; 62: 49-53
  • 26) Faselis C, Kokkinos P, Tsimploulis A, Pittaras A, Myers J, Lavie CJ, Kyritsi F, Lovic D, Karasik P, Moore H: Exercise Capacity and Atrial Fibrillation Risk in Veterans: A Cohort Study. Mayo Clin Proc 2016; 91: 558-566
  • 27) Fiala M, Bulkova V, ?knouril L, Nevralova R, Toman O, Januska J, Spinar J, Wichterle D: Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation. Europace 2017; 19: 1781-1789
  • 28) Mujovic NM, Marinkovic MM, Nedeljkovic I, Markovic N, Banovic M, Vucicevic V, Stankovic G, Potpara TS: Improvement of Maximal Exercise Performance After Catheter-Ablation of Atrial Fibrillation and Its Prognostic Significance for Long-Term Rhythm Outcome. J Am Heart Assoc 2021; 10: e017445
  • 29) Myrstad M, Malmo V, Ulimoen SR, Tveit A, Loennechen JP: Exercise in individuals with atrial fibrillation. Clin Res Cardiol 2019; 108: 347-354
  • 30) Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, Wisloff U, Loennechen JP: Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial. Circulation 2016; 133: 466-473
  • 31) Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U: Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation -A randomized controlled trial. PLoS One 2017; 12: e0170060
  • 32) Risom SS, Zwisler AD, Rasmussen TB, Sibilitz KL, Madsen TL, Svendsen JH, Gluud C, Lindschou J, Winkel P, Berg SK: Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial. Am Heart J 2016; 181: 120-129
  • 33) Luo N, Merrill P, Parikh KS, Whellan DJ, Pina IL, Fiuzat M, Kraus WE, Kitzman DW, Keteyian SJ, O'Connor CM, Mentz RJ: Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation. J Am Coll Cardiol 2017; 69: 1683-1691
  • 34) Rienstra M, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brugemann J, Geelhoed B, Tieleman RG, Hillege HL, Tukkie R, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC; RACE 3 Investigators: Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial. Eur Heart J 2018; 39: 2987-2996.