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J Am Heart Assoc. 2018 Feb 24;7(5). pii: e008146. doi: 10.1161/JAHA.117.008146.

Physical Activity Measured by Implanted Devices Predicts Atrial Arrhythmias and Patient Outcome: Results of IMPLANTED (Italian Multicentre Observational Registry on Patients With Implantable Devices Remotely Monitored).

Author information

1
Cardiology Unit "Card. G. Panico" Hospital, Tricase, Italy dr.palmisano@libero.it.
2
Cardiology and Arrhythmology Clinic, Marche Polytechnic University University Hospital "Umberto I-Lancisi-Salesi,", Ancona, Italy.
3
Department of Cardiology, Monaldi Hospital Second University of Naples, Italy.
4
Institute of Cardiology, University of Bologna S.Orsola-Malpighi University Hospital, Bologna, Italy.
5
"Vito Fazzi" Hospital, Lecce, Italy.
6
Division of Cardiology, University of Eastern Piedmont Maggiore della Carità Hospital, Novara, Italy.
7
Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
8
Cardiology Unit "Card. G. Panico" Hospital, Tricase, Italy.
9
Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy.
10
Cardiology Department, University of Modena and Reggio Emilia Policlinico di Modena, Italy.

Abstract

BACKGROUND:

To determine whether daily physical activity (PA), as measured by implanted devices (through accelerometer sensor), was related to the risk of developing atrial arrhythmias during long-term follow-up in a population of heart failure (HF) patients with an implantable cardioverter defibrillator (ICD).

METHODS AND RESULTS:

The study population was divided into 2 equally sized groups (PA cutoff point: 3.5 h/d) according to their mean daily PA recorded by the device during the 30- to 60-day period post-ICD implantation. Propensity score matching was used to compare 2 equally sized cohorts with similar characteristics between lower and higher activity patients. The primary end point was time free from the first atrial high-rate episode (AHRE) of duration ≥6 minutes. Secondary end points were: first AHRE ≥6 hours, first AHRE ≥48 hours, and a combined end point of death or HF hospitalization. Data from 770 patients (65±15 years; 66% men; left ventricular ejection fraction 35±12%) remotely monitored for a median of 25 months were analyzed. A PA ≥3.5 h/d was associated with a 38% relative reduction in the risk of AHRE ≥6 minutes (72-month cumulative survival: 75.0% versus 68.1%; log rank P=0.025), and with a reduction in the risk of AHRE ≥6 hours, AHRE ≥48 hours, and the combined end point of death or HF hospitalization (all P<0.05).

CONCLUSIONS:

In HF patients with ICD, a low level of daily PA was associated with a higher risk of atrial arrhythmias, regardless of the patients' baseline characteristics. In addition, a lower daily PA predicted death or HF hospitalization.

KEYWORDS:

atrial fibrillation; heart failure; implanted cardioverter defibrillator; physical exercise

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