Validity of cardiac implantable electronic devices in assessing daily physical activity
Introduction
Regular physical activity and exercise improve quality of life and exercise tolerance in heart failure patients, whereas a decrease in physical activity indicates disease progression [1], [2], [3], [4], [5], [6]. Hence, monitoring physical activity is important in the clinical management of these patients. Implantable cardioverter-defibrillators and cardiac resynchronization therapy devices (ICD/CRT) are routinely equipped with activity sensors in order to adjust heart rates during patient activity. Thus, data on daily physical activity assessed by these sensors can easily be obtained on ICD/CRT interrogation. This information is available irrespective of the activation of the rate response function. Several studies have used these data to monitor physical activity and to derive prognostic information [7], [8], [9], [10]. However, no study has so far evaluated the activity amounts assessed by ICD/CRT devices regarding their clinical applicability. Therefore, the aim of this study was to compare data on daily physical activity assessed by ICD/CRT devices to activity data measured by a validated external accelerometer [4], [11] in heart failure patients.
Section snippets
Materials and methods
The study was a prospective analysis of consecutive male and female heart failure patients of all ages who had received Medtronic ICD/CRT devices for primary or secondary preventive purposes ≥ 6 months earlier. Participants were recruited in the outpatient clinic of the German Heart Center in Munich from June to December 2010. Only clinically stable, medically optimally treated patients were included; no cut-off value for left ventricular ejection fraction was used. Patients with physical
Results
A total of 73 patients were included; baseline characteristics are shown in Table 1. Mean total daily activity of all participants was 276 ± 85 min as assessed by the AiperMotion and 237 ± 105 min as assessed by the ICD/CRT activity sensor, resulting in a mean difference between both measurements of 39 ± 83 min (p < 0.001). The average time spent in the different activity modes of the AiperMotion was distributed as follows: “active” 177 ± 54 min, “slow walking” 82 ± 36 min, “fast walking” 6 ± 12 min, “running” 0
Discussion
This study compared activity data of a validated external accelerometer to activity data deriving from ICD/CRT devices in heart failure patients. Although the intra-individual correlation was strong, Bland Altman plot revealed broad variations of activity measurements between the two methods with differences up to several hours per day. Differences were not predicted by NYHA functional class, age, ejection fraction, underlying disease or type of device. Thus, non-validated ICD/CRT activity
Acknowledgments
The authors wish to thank Michaela Herold and Markus Renner from Medtronic, Neuss, Germany and Martin Ertlmeier of Aipermon, Munich, Germany for their continuous, friendly and professional support and for reading and approving the manuscript.
Funding
None.
Conflicts of interest
Author Christof Kolb has received lecture fees from Medtronic and performs other studies which are financially supported by Medtronic. All other authors report no conflict of interest.
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Cited by (20)
Physical Activity in Cardiac Implantable Electronic Device Recipients During the COVID-19 Pandemic
2022, Mayo Clinic ProceedingsCitation Excerpt :However, prior studies have reported on the reliability of CIED-derived PA data. For example, Pressler et al22 reported an excellent intra-individual correlation between a CIED PA sensor and an external accelerometer. Subsequently, several studies have used CIED sensor–derived data to assess PA and to predict early worsening of heart failure, establishing the validity of this technique.23,24
Accelerometer-assessed physical behavior and the association with clinical outcomes in implantable cardioverter-defibrillator recipients: A systematic review
2022, Cardiovascular Digital Health JournalCitation Excerpt :Although there were moderate-to-strong intrapersonal correlations between wearable accelerometry (triaxial accelerometer) and device-embedded accelerometry (uniaxial accelerometer), studies reported large variations in total daily activity between device-embedded accelerometry and wearable accelerometry (Supplemental Table 5).17–19 There was an underestimation of approximately 0.8 hours in daily activity measured using device-embedded accelerometry compared to validated wearable accelerometers.18,19 This systematic review displays the body of evidence with respect to the utility of accelerometer-measured PB in ICD carriers and high-risk SCD patients.
Patient Activity Decreases and Mortality Increases After the Onset of Persistent Atrial Fibrillation in Patients With Implantable Cardioverter-Defibrillators
2016, JACC: Clinical ElectrophysiologyCitation Excerpt :Modern ICD technology incorporates single-axis accelerometers designed to measure patient activity in daily number of minutes (Online Figure 1B) (11). An active minute corresponds to approximately 70 steps/min (12) and was validated with external 3-axis accelerometers (13). The average (with standard error) daily activity was calculated over 7 consecutive day windows (Online Figure 1B).
Stratifying patients at the risk of heart failure hospitalization using existing device diagnostic thresholds
2015, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :An algorithm then converts these electrical signals to number of minutes active for the entire 24-h duration during a day (day and night time activities are not reported separately), where a minute is considered active if accelerometer registers signal equivalent to 70 steps/min or greater.4 The device recorded activity has been shown to have a strong intra-individual correlation with activity measured using a validated external sensor.5 However, details of the algorithm differ between implantable and external devices (e.g. pedometers and external accelerometers) and absolute duration of reported activity between the two may differ.
Device-measured physical activity versus six-minute walk test as a predictor of reverse remodeling and outcome after cardiac resynchronization therapy for heart failure
2014, American Journal of CardiologyCitation Excerpt :Notwithstanding this, a recent study by Pressler et al failed to validate the measurements of implanted devices using external accelerometers. They observed that daily physical activity assessed by CRT/ICD devices showed strong intraindividual correlations but differ substantially regarding the absolute amount of physical activity, compared with external sensors.18 It appears that within the same individual, however, that device-based measures provide a good comparison with track changes in the level of physical activity.15