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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.693458

DOI=10.3389/fcvm.2021.693458

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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%, <italic>P</italic> = 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, <italic>P</italic> &lt; 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, <italic>P</italic> &lt; 0.001) and all-cause mortality (HR = 2.803, 95% CI:1.732–4.535, <italic>P</italic> &lt; 0.001).</p><p><bold>Conclusion:</bold> 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.</p>