Utilization of Novel Technology to Optimize Cardiac Rehabilitation in Children Supported with Ventricular Assist Devices during the COVID-19 Era

Study: Cardiac rehabilitation is critical for successful ventricular assist device (VAD) support in children. Regular in-person rehabilitation can be a challenge, particularly during the COVID-19 era. Methods: We present 2 cases of adolescents supported with VADs in whom wearable devices and a virtual exercise platform were used to augment cardiac rehabilitation. Results: A 17-year-old male with tachycardia induced cardiomyopathy underwent LVAD implantation as a bridge to decision. The distance from the hospital and COVID restriction made frequent visits for cardiac rehabilitation not feasible, yet aerobic activity was critical for myocardial remodeling. A 15-year-old severely obese female with dilated cardiomyopathy underwent LVAD implantation as a bridge to candidacy. Engaging her in physical activity was a challenge, but a necessary component of her evaluation for bariatric surgery. For both patients, wearable devices (Fitbit Versa 2) were placed to monitor and incentivize activity. Exercises were designed based on available resources and include walking up stairs and using resistance bands. Despite no palpable pulse both patients had a pulse that registered on their wearable device, which helped to monitor rehabilitation. Devices were paired with the MyHeart CHOP application, a virtual platform for home exercise training that includes individualized exercise prescriptions and the opportunity for virtual communication with a pediatric cardiac exercise physiologist. In the >1 month since incorporation of wearable technology, both patients have participated in rehabilitation sessions on >50% of eligible days (25/31 d, 19/33 d) and are being considered for VAD explant and bariatric surgery. Technologybased remote rehabilitation programs are a promising and feasible option for children supported with VADs during the COVID era, and may be an underutilized method by which to optimize outcomes.