Physical rehabilitation in heart failure with reduced ejection fraction: are the cardiac implantable devices a barrier?

The development of implantable cardiac devices brought a spectacular improvement in the prognosis of patients with heart failure with reduced ejection fraction, reducing the risk of sudden cardiac death by implanting a cardiac defibrillator, improving ventricular remodeling through cardiac resynchronization and, at the same time, increasing the pa-tient's functional capacity, reducing decompensation episodes and hospitalization. Phys-ical training at moderate exercise intensity is safe and effective in patients with heart fail-ure and cardiac implantable devices; even if they have a severely impaired effort capacity and device-related issues, the assessment of the disease status and of the device parame-ters before the enrollment in the training program warrants the improvement of physical performance and disease outcomes without notable adverse events.