PERI-IMPLANT ACTIVITY RESTRICTION IN CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE PATIENTS: DOES ACTIVITY RESTRICTION RESULT IN LONG-TERM RATES OF LOW-LEVEL ACTIVITY IN PATIENTS?

Abstract

Cardiovascular implantable electronic devices (CIEDs), specifically implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) are life-saving devices utilized to care for patients at risk for sudden cardiac arrest. ICDs and CRT-Ds have become increasingly used worldwide and within the United States (US), with over 110,000 devices implanted every year in the US (Green et al., 2016). The implantation procedure for the ICD and CRT-D limits patients from engaging in activities that require using their arm or lifting heavy objects from 4-6 weeks post-implant. Physical activity is limited to allow the implanted leads time to become fibrosed. Regardless, cardiac patients need to return to physical activity for both its physical and mental benefits. The resumption of activity following this time is likely variable, but no published information is available to determine the impact or duration of physical activity restriction. Importantly, all modern ICDs and CRT-Ds have an accelerometer in the device that can continuously monitor patient movement and physical activity and store the data. Research has consistently highlighted that physical activity is a predictor of cardiovascular outcomes and patients’ quality of life, specifically in individuals with CIEDs (Rosman et al., 2018). Given that many of these patients already struggle with engagement in physical activity, coupled with the adjustment to a new device and recovery restrictions, it is plausible that this may impact their levels of activity. Additionally, many patients endure an increase in psychological stressors post-implantation, such as a fear of shocks which may also contribute to a reduction in activity consequently impacting their quality of life (Sears et al., 2023). Changes in health status may also impact patients’ activity levels such as new-onset atrial fibrillation, atrial tachycardia, or ICD shock experiences. Lastly, given the high incidence of cardiovascular disease and decreased resources within rural areas, this may result in lower levels of physical activity (Turecamo et al., 2023). The combination of recovery restrictions, psychological factors, rurality, and the onset of symptoms may create a burden on patients that influences their engagement in physical activity in turn, impacting their long-term cardiovascular outcomes. The present study aimed to determine how peri-implant activity restrictions within ICD and CRT-D patients seen in a rural-serving cardiology clinic impact long-term rates of activity engagement for up to 6 months post procedure. 294 patients from ECU Health who have a Biotronik ICD or CRT-D device that were in the archival data set from 2014 to 2023 were included in the study. Descriptive analyses revealed that the mean age of the sample was 61.76 (SD = 12.29) with 67.79% identifying as male and 52.04% identifying their racial/ethnic background as non-Hispanic Black. Pre-existing cardiac and psychological co-morbidities prior to device implantation were common within the sample and the majority of the sample received their device due to heart failure (79.93%). Major findings of the present study included a) plateaued activity levels after two months following device implantation (95.90 minutes per day in month 1 and 116.93 minutes per day in month 2) b) no significant difference in activity levels between patients with device detected atrial arrhythmias vs. patients without arrhythmias and c) no significant difference in activity levels between patients who experienced defibrillator shocks vs. patients who had not. The findings in the present study demonstrated decreased physical activity patterns up to 6 months following implantation in a rural-serving clinic. In the future, device and accelerometer data should be utilized for research and to determine mechanisms of utilization to provide interventions, improve patient care, patient quality of life, and overall health outcomes.