The incidence of ventricular arrhythmias in rehabilitated post-myocardial infarction (MI) patients with left ventricular dysfunction included in a long-term rehabilitation program was assessed and compared with that in similar patients who were not in such a program. Thirty-eight post-MI patients (2 to 19 years after the acute event) with ejection fraction <40% were investigated by 48-hour Holter monitoring. They were divided into the following 3 groups: group I, 11 patients who underwent arm training for 60 months; group II, 11 patients who underwent calisthenics for 36 months; and group III, 16 patients who were not in any rehabilitation program; the age of the patients was 61 ± 7, 61 ± 6 and 61 ± 9 years, respectively, (p = not significant). Ejection fraction at rest was 31 ± 9 for group I, 29 ± 7 for group II, and 29 ± 7 for group III (p = not significant). There were no significant differences concerning the location of Ml, and antiarrhythmic treatment received by patients from all groups. At the conclusion of 48-hour Holter monitoring, 2 blood samples were obtained for assessment of norepinephrine (at rest and after postural change). Quality of life was determined by a detailed questionnaire, including questions concerning social activity, life satisfaction and sexual function. After 36 and 60 months, an improvement in hemodynamic condition of patients in group I was noted. Quality of life was higher in the rehabilitated patients, with enhanced emotional stability, satisfaction with work and social life, and a high percentage of return to work (82 vs 40%). The lowest levels of norepinephrine were found in group I and the highest in group III (p < 0.02), whereas they were within normal limits in group II. Isolated ventricular premature beats (>60/hour) were found in 1 (10%), 2 (18%) and 9 (56%) patients (p < 0.05), and complex ventricular arrhythmias in 4 (33%), 3 (27%) and 12 (77%) patients (p < 0.05) in groups I, II and III, respectively. Nonsustained ventricular tachycardia was recorded in 2 patients (17%) from group I with 4 episodes, 2 patients (17%) from group II with 7 episodes, and 6 patients (37%) from group III with 24 episodes (p < 0.03); 3 of the latter patients had complex ventricular arrhythmias also. It appears that a long-term comprehensive rehabilitation program decreases neuroadrenergic activity, the arrhythmogenic effect of catecholamines and consequently, the incidence of ventricular arrhythmias.

Among primary cardiac diseases, hypertrophic cardiomyopathy (HC) is known for its diverse clinical manifestations1 and different morphologic aspects.2 The clinical picture ranges from an asymptomatic form, corresponding with a mild, nonobstructive ventricular septal hypertrophy, to the disabled patient with impaired cardiac function or even sudden death,3 when a massive myocardial thickening and a very small left ventricular cavity can be found.5 Scarce data are available about the natural history of mild, nonobstructive HC.5 The present study explores this abnormality to see if it progresses to a more severe form of HC and if it results in any complications.