University Hospital Giessen and Marburg, Giessen, Germany.
Biotronik SE & CO. KG, Berlin, Germany.
Pacing Clin Electrophysiol. 2022 Apr;45(4):471-480. doi: 10.1111/pace.14443. Epub 2022 Jan 17.
Restricted outdoor activity during COVID-19 related lockdown may accelerate heart failure (HF) progression and thereby increase cardiac arrhythmias. We analyzed the impact of March/April 2020 lockdown on physical activity and arrhythmia burden in HF patients treated with cardiac resynchronization therapy (CRT) devices with daily, automatic remote monitoring (RM) function.
The study cohort included 405 HF patients enrolled in Observation of Clinical Routine Care for Heart Failure Patients Implanted with BIOTRONIK CRT Devices (BIO|STREAM.HF) registry in 16 countries, who had left ventricular ejection fraction (LVEF) ≤40% (mean 28.2 ± 6.6%) and NYHA class II/III/IV (47.9%/49.6%/2.5%) before CRT pacemaker/defibrillator implantation. The analyzed RM data comprised physical activity detected by accelerometer, mean heart rate and nocturnal rate, PP variability, percentage of biventricular pacing, atrial high rate episode (AHRE) burden, ventricular extrasystoles and tachyarrhythmias, defibrillator shocks, and number of implant interrogations (i.e., follow-ups). Intraindividual differences in RM parameters before (4-week period) versus during (4-week period) lockdown were tested for statistical significance and independent predictors were identified.
There was a significant relative change in activity (mean -6.5%, p < .001), AHRE burden (+17%, p = .013), and follow-up rate (-75%, p < .001) during lockdown, with no significant changes in other RM parameters. Activity decreased by ≥8 min/day in 46.5% of patients; predictors were higher LVEF, lower NYHA class, no defibrillator indication, and more activity before lockdown. AHRE burden increased by ≥17 min/day in 4.7% of patients; predictors were history of atrial fibrillation, higher LVEF, higher body mass index, and activity decrease during lockdown.
Unfavorable changes in physical activity, AHRE burden, and follow-up rate were observed during lockdown, but not in ventricular arrhythmia.
与 COVID-19 相关封锁期间限制户外活动可能会加速心力衰竭（HF）的进展，从而增加心律失常。我们分析了 2020 年 3 月/4 月封锁对接受心脏再同步治疗（CRT）设备（具有日常自动远程监测（RM）功能）治疗的 HF 患者的身体活动和心律失常负担的影响。
研究队列包括在 16 个国家/地区参与观察心脏再同步治疗设备植入心力衰竭患者常规护理（BIO|STREAM.HF）注册研究的 405 名 HF 患者，这些患者在 CRT 起搏器/除颤器植入前左心室射血分数（LVEF）≤40%（平均 28.2±6.6%）和 NYHA 心功能分级 II/III/IV 级（47.9%/49.6%/2.5%）。分析的 RM 数据包括加速度计检测到的身体活动、平均心率和夜间心率、PP 变异性、双心室起搏百分比、心房高频事件（AHRE）负担、室性期前收缩和心动过速、除颤器电击和植入询问次数（即随访次数）。测试了 RM 参数在封锁前后（4 周）的个体内差异的统计学意义，并确定了独立预测因子。
在封锁期间，活动（平均 -6.5%，p<0.001）、AHRE 负担（+17%，p=0.013）和随访率（-75%，p<0.001）有显著的相对变化，而其他 RM 参数没有显著变化。46.5%的患者活动减少≥8 分钟/天；预测因子是 LVEF 较高、NYHA 心功能分级较低、无除颤器指征和封锁前活动较多。4.7%的患者 AHRE 负担增加≥17 分钟/天；预测因子是心房颤动史、LVEF 较高、体重指数较高和封锁期间活动减少。
在封锁期间观察到身体活动、AHRE 负担和随访率的不利变化，但心室性心律失常没有变化。
