Kutyifa Valentina, Christof Michael, Mullane Steven, Harrell Camden, Singh Jagmeet, Chinitz Larry, Varma Niraj, Piccini Jonathan P, Turakhia Mintu P, Rosero Spencer Z
Division of Cardiology, Department of Medicine, University of Rochester, Rochester, New York.
Division of Cardiology, Biotronik Inc., Lake Oswego, Oregon.
Heart Rhythm O2. 2024 Aug 20;5(11):805-812. doi: 10.1016/j.hroo.2024.07.020. eCollection 2024 Nov.
There have been limited data examining the temporal relationship between device-derived daily activity and ventricular arrhythmias (VAs).
We aimed to assess whether activity predicted VAs or VAs predicted changes in activity.
The CERTITUDE registry includes over 55,000 implanted devices active on Home Monitoring. Daily data on activity are captured by a 1-axis accelerometer. Temporal changes in activity during treated VAs were analyzed using the first event and 7-day activity windows (baseline, pre-event, and postevent). Baseline period was defined as 31 to 38 days prior to VA. VAs were categorized by heart rate (≤200 beats/min, >200 beats/min) and treatment (shock or antitachycardia pacing). Differences were assessed using the binomial proportion test and case-crossover analysis.
A total of 5631 devices (3688 implantable cardioverter-defibrillators, 1943 cardiac resynchronization therapy defibrillators) were analyzed with a cumulative follow-up duration of 18,354 years (5.6 million days). Patients with VA events >200 beats/min with shock (n = 593) had a significant decline in activity post-VA with a median -8.7% reduction (interquartile range -24.6% to 7.3%, 0.001). However, there was no reduction in activity before VA events >200 beats/min ( .690) or before or after VA events >200 beats/min with antitachycardia pacing. However, VA events ≤200 beats/min with shock had reductions in activity following the event (-5.8%, interquartile range -29.5% to 12.3%, .003). Case-crossover analyses confirmed lower activity rates following for VA events >200 beats/min with shock.
In the CERTITUDE registry, we have shown a temporal decline in device-derived activity following VA events >200 beats/min and for VA events <200 beats/min treated with a shock, but we did not find changes in activity preceding a shock event.
关于设备记录的日常活动与室性心律失常（VA）之间的时间关系的数据有限。
我们旨在评估活动是否能预测VA，或者VA是否能预测活动的变化。
CERTITUDE注册研究纳入了超过55000台开启家庭监测功能的植入式设备。每日活动数据由单轴加速度计采集。使用首次事件和7天活动窗口（基线期、事件前和事件后）分析治疗性VA期间活动的时间变化。基线期定义为VA发生前31至38天。VA根据心率（≤200次/分钟、>200次/分钟）和治疗方式（电击或抗心动过速起搏）进行分类。使用二项比例检验和病例交叉分析评估差异。
共分析了5631台设备（3688台植入式心律转复除颤器、1943台心脏再同步治疗除颤器），累积随访时间为18354年（560万天）。VA事件>200次/分钟且接受电击治疗的患者（n = 593）在VA发生后活动显著下降，中位数下降8.7%（四分位间距为-24.6%至7.3%，P<0.001）。然而，VA事件>200次/分钟之前（P = 0.690）或VA事件>200次/分钟且接受抗心动过速起搏治疗的事件前后，活动均无下降。但是，VA事件≤200次/分钟且接受电击治疗的患者在事件后活动下降（-5.8%，四分位间距为-29.5%至12.3%，P = 0.003）。病例交叉分析证实，VA事件>200次/分钟且接受电击治疗后活动率较低。
在CERTITUDE注册研究中，我们发现VA事件>200次/分钟以及VA事件<200次/分钟且接受电击治疗后，设备记录的活动随时间下降，但未发现电击事件前活动有变化。
