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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).

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Cardiology Unit "Card. G. Panico" Hospital, Tricase, Italy
Cardiology and Arrhythmology Clinic, Marche Polytechnic University University Hospital "Umberto I-Lancisi-Salesi,", Ancona, Italy.
Department of Cardiology, Monaldi Hospital Second University of Naples, Italy.
Institute of Cardiology, University of Bologna S.Orsola-Malpighi University Hospital, Bologna, Italy.
"Vito Fazzi" Hospital, Lecce, Italy.
Division of Cardiology, University of Eastern Piedmont Maggiore della Carità Hospital, Novara, Italy.
Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
Cardiology Unit "Card. G. Panico" Hospital, Tricase, Italy.
Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy.
Cardiology Department, University of Modena and Reggio Emilia Policlinico di Modena, Italy.



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).


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).


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.


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

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