Association Between Changes in Physical Activity and New-Onset Atrial Fibrillation After ICD/CRT-D Implantation

Xuerong Sun; Shuang Zhao; Keping Chen; Wei Hua; Yangang Su; Wei Xu; Fang Wang; Xiaohan Fan; Yan Dai; Zhimin Liu; Shu Zhang

doi:10.3389/fcvm.2021.693458

Association Between Changes in Physical Activity and New-Onset Atrial Fibrillation After ICD/CRT-D Implantation

Front Cardiovasc Med. 2021 Aug 26:8:693458. doi: 10.3389/fcvm.2021.693458. eCollection 2021.

Authors

Xuerong Sun¹, Shuang Zhao¹, Keping Chen¹, Wei Hua¹, Yangang Su², Wei Xu³, Fang Wang⁴, Xiaohan Fan¹, Yan Dai¹, Zhimin Liu¹, Shu Zhang¹

Affiliations

¹ Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China.
⁴ Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Background: Changes in physical activity (PA) after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) implantation were unknown. The association of PA changes with new-onset atrial fibrillation (AF), cardiac death and all-cause mortality was unclear in patients at high risk of sudden cardiac death. Methods: Patients receiving ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed. Changes in PA were considered from baseline status to 1 year after implantation. New-onset AF was defined as the first atrial high-rate episode ≥1% of the daily AF burden detected after implantation. Results: Over a mean follow-up of 50.3 months, 124 new-onset AF events (36.2%), 61 cardiac deaths (17.8%), and 87 all-cause deaths (25.4%) were observed in 343 patients with ICD/CRT-D implantation. PA at 1 year after implantation was increased compared with PA at baseline (11.97 ± 5.83% vs. 10.82 ± 5.43%, P = 0.008), and PA at 1 year was improved in 210 patients (61.2%). Per 1% decrease in PA was associated with 12.4, 18.3, and 14.3% higher risks of new-onset AF, cardiac death and all-cause mortality, regardless of different baseline characteristics. Patients with decreased PA had 2-fold risks of new-onset AF (hazard ratio [HR] = 1.972, 95% confidence interval [CI]: 1.352-2.877, P < 0.001) as high as those with unchanged/increased PA. Decreased PA was an independent risk factor for cardiac death (HR = 3.358, 95% CI: 1.880-5.996, P < 0.001) and all-cause mortality (HR = 2.803, 95% CI:1.732-4.535, P < 0.001). Conclusion: PA decrease after ICD/CRT-D implantation is associated with a higher incidence of new-onset AF, resulting in worsened outcomes in cardiac death and all-cause mortality.

Keywords: all-cause mortality; atrial fibrillation; cardiac death; changes in physical activity; implantable cadioverter defibrillators.