Physical Activity and Sudden Cardiac Death

Abstract Background Cardiovascular implantable electronic devices (CIEDs) with physical activity (PA) recording function can continuously and automatically collect patients’ long-term PA data. The dose-response association of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRTD)-measured PA with cardiovascular outcomes in patients at high risk of sudden cardiac death (SCD) was investigated. Methods In total, 822 patients fulfilling the inclusion criteria were included and divided into three groups according to baseline PA tertiles: tertile 1 (< 8.04%, n = 274), tertile 2 (8.04–13.24%, n = 274), and tertile 3 (> 13.24%, n = 274). The primary endpoint was cardiac death, the secondary endpoint was all-cause mortality. Results During a mean follow-up of 59.7 ± 22.4 months, cardiac death (18.6% vs 8.8% vs 5.5%, tertiles 1–3, P < 0.001) and all-cause mortality (39.4% vs 20.4% vs 9.9%, tertiles 1–3, P < 0.001) events decreased according to PA tertiles. Compared with patients younger than 60 years old, older patients had a lower average PA level (9.6% vs 12.8%, P < 0.001) but higher rates of cardiac death (13.2% vs 8.1%, P = 0.024) and all-cause mortality (28.4% vs 16.7%, P < 0.001) events. Adjusted multivariate Cox regression analyses showed that a higher tertile of PA was associated with a lower risk of cardiac death (hazard ratio (HR) 0.41, 95% confidence interval (CI): 0.25–0.68, tertile 2 vs tertile 1; HR 0.28, 95% CI: 0.15–0.51, tertile 3 vs tertile 1, Ptrend < 0.001). Similar results were observed for all-cause mortality. The dose-response curve showed an inverse non-linear pattern, and a significant reduction in endpoint risk was observed at the low-moderate PA level. The HR for cardiac death was reduced by half with 12.32% PA (177 min), and the HR for all-cause mortality was reduced by half with 11.92% PA (172 min). Subgroup analysis results indicated that older adults could benefit from PA and the range for achieving optimal benefits might be lower. Conclusions PA monitoring may aid in long-term management of patients at high risk of SCD. More PA will generate better survival benefits, but even low-moderate PA is already good especially for older adults, which is relatively easy to achieve.

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Sudden cardiac death: Prevention and recommendations for physical activity

Godisnjak Fakulteta sporta i fizickog vaspitanja ◽

10.5937/gfsfv1924093z ◽

2019 ◽

pp. 93-106

Author(s):

Igor Zlatović ◽

Slobodanka Dobrijević ◽

Marija Macura

Keyword(s):

Physical Activity ◽

Sudden Cardiac Death ◽

Cardiac Death

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Causes of sudden cardiac death in athletes

Medicinski pregled ◽

10.2298/mpns0702061p ◽

2007 ◽

Vol 60 (1-2) ◽

pp. 61-65

Author(s):

Dejana Popovic ◽

Miodrag Ostojic ◽

Nada Popovic ◽

Stanimir Stojiljkovic ◽

Ljiljana Scepanovic

Keyword(s):

Physical Activity ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Vigorous Physical Activity ◽

The Body ◽

Functional Changes ◽

Blunt Impact ◽

Dilatative Cardiomyopathy ◽

Physical Examinations ◽

The Right

Introduction Sudden cardiac death in athletes is a growing problem, despite the huge existing knowledge in medicine and sports. Effects of vigorous physical activity In response to vigorous physical activity, the body undergoes profound morphologic and functional changes. These changes are usually healthy, but sometimes may gravitate to some cardiac diseases. But still, most sudden cardiac deaths are due to previous unknown diseases. Causes of sudden cardiac death The most common cause of sudden cardiac death in athletes is hypertrophic cardiomyopathy. Other reasons are congenital coronary artery anomalies, myocarditis, dilatative cardiomyopathy, arrhythmogenic cardiomyopathy of the right ventricle, sarcoidosis, mitral valve prolapse, aortic valve stenosis, atherosclerosis, long QT syndrome, and blunt impact to the chest. Conclusion Bearing in mind the above mentioned, more frequent physical examinations of athletes are recommended.

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Physical Activity, Physical Fitness, and Sudden Cardiac Death

Epidemiologic Reviews ◽

10.1093/oxfordjournals.epirev.a036091 ◽

1992 ◽

Vol 14 (1) ◽

pp. 37-58 ◽

Cited By ~ 76

Author(s):

H. W. Kohl ◽

K. E. Powell ◽

N. F. Gordon ◽

S. N. Blair ◽

R. S. Paffenbarger

Keyword(s):

Physical Activity ◽

Sudden Cardiac Death ◽

Physical Fitness ◽

Cardiac Death

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Abstract 10068: Cardiorespiratory Fitness Modifies the Association Between Leisure-Time Physical Activity and the Risk of Sudden Cardiac Death Among Middle-Aged Men

Circulation ◽

10.1161/circ.132.suppl_3.10068 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Magnus J Hagnäs ◽

Timo A Lakka ◽

Sudhir Kurl ◽

Timo H Mäkikallio ◽

Kai Savonen ◽

...

Keyword(s):

Physical Activity ◽

Sudden Cardiac Death ◽

Cardiorespiratory Fitness ◽

Cardiac Death ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Population Sample ◽

Middle Aged ◽

Metabolic Equivalents ◽

Increased Risk

Aim: We investigated whether cardiorespiratory fitness (CRF) modifies the association between leisure-time physical activity (LTPA) and the risk of sudden cardiac death (SCD) among middle-aged men. Methods: The participants were a population sample of 2656 Finnish men aged 42-60 years at baseline. The mean follow-up time was 21 years. LTPA was assessed with a questionnaire and was expressed in kilocalories per day (kcal/d). CRF was measured directly using respiratory gas analysis during maximal exercise test and was expressed in metabolic equivalents (METs). The participants were divided into following 4 groups using the lowest tertiles of CRF (7.9 METs) and LTPA (< 191 kcal/d) as cut-offs: high CRF and LTPA, high CRF and low LTPA, low CRF and high LTPA and low CRF and LTPA. The risk of SCD was analysed using Cox regression models adjusted for age, smoking, alcohol consumption, body mass index, systolic blood pressure, low density lipoprotein cholesterol, C-reactive protein, prevalent type 2 diabetes and prevalent coronary heart disease. Results: Men with low CRF and low LTPA had a 1.8 (95% confidence interval 1.3-2.6, p=0.001) times higher risk of SCD than men with high CRF and high LTPA. The amount of LTPA did not significantly alter the risk of SCD among men with high CRF. Figure 1 shows the cumulative survival from SCD in the 4 groups. Conclusions: Our study shows that men with low CRF and low LTPA have increased risk of SCD. This finding emphasizes increasing LTPA to prevent SCD among men and particularly among those with low CRF.

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P309R' wave in precordial leads V1-V2 in patients from the young SCD-SOS cohort

European Heart Journal ◽

10.1093/eurheartj/ehz747.0144 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Carrington ◽

A Creta ◽

R Santos ◽

R Teixeira ◽

L Goncalves ◽

...

Keyword(s):

Physical Activity ◽

Sudden Cardiac Death ◽

Sudden Death ◽

Cardiac Death ◽

Young Patients ◽

Male Gender ◽

Warning Signs ◽

Qtc Interval ◽

Validated Questionnaire ◽

Unexplained Syncope

Abstract Introduction Sudden Cardiac Death – Screening Of risk factorS (SCD-SOS) survey aimed to screen for warning signs of potential channelopathies and cardiomyopathies that may course with sudden cardiac death in the young (≤40 years old) and consisted in an ECG and a digital-based previously validated questionnaire. Purpose We aimed to study clinical and electrocardiographic characteristics of young patients from the SCD-SOS cohort who presented with an r'-wave in precordial leads V1 and V2. Methods All the ECG were screened for the detection of an r'-wave in precordial leads V1 and V2. The ECGs selected were reviewed by a second investigator (agreed in 97.7% of the cases). We performed classical descriptive statistics and multivariate logistic regression to compare patients with and without r'-wave in these leads. Results From a total of 14669 patients who had an ECG performed as part of the SCD-SOS survey, 17% displayed an r'-wave in precordial leads V1 and V2 and 0.4% had complete right bundle branch block (RBBB). Patients with rSr' pattern had a mean age of 20±5 years old, 54% of them were male, they had a mean body mass index (BMI) of 22±3kg/m2, and 54% practiced sports regularly, with a mean of 5±4 hours of physical activity per week. Regarding previous symptoms reported by these individuals, 24% (n=487) reported a transient loss of consciousness, 15% (n=310) a reflex syncope, 3% (n=58) had unexplained syncope and 21% (n=425) palpitations. Sudden death in relatives before 50 years-old was present in 11% (n=172) of the patients with an r'-wave in V1-V2. After adjusting for heart rate and physical activity, PQ interval (OR 1.007 - CI95% 1.004–1.010, p<0.001), QTc interval (OR 1.009 - CI95% 1.005–1.012, p<0.001), male gender (OR 2.438 - CI95% 2.144–2.772, p<0.001) and BMI (OR 0.881 - CI95% 0.864–0.900, p<0.001) were independently associated with the presence of r'wave in precordial leads V1-V2. Unexplained syncope, palpitations and family history of sudden death were not associated with r'-wave in the young SCD-SOS population. Conclusions We conclude that r'-wave in V1-V2 is a frequent finding in the young population and that it is associated with higher PQ and QTc intervals. The prognostic implications of this pattern are unknown, but thorough differential diagnosis is warranted since this pattern may correspond to incomplete RBBB/athlete's ECG, and may also be suggestive of other potentially serious conditions such as Type 2 Brugada pattern and multiple causes of right ventricular enlargement. Finally, this pattern is also associated with male gender and lower BMI, suggesting a dependence on anatomical factors.

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Association of the Obesity Paradox With Objective Physical Activity in Patients at High Risk of Sudden Cardiac Death

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa659 ◽

2020 ◽

Vol 105 (12) ◽

pp. e4801-e4810

Author(s):

Xiaoyao Li ◽

Keping Chen ◽

Wei Hua ◽

Yangang Su ◽

Jiefu Yang ◽

...

Keyword(s):

Physical Activity ◽

High Risk ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Electronic Device ◽

Home Monitoring ◽

Obesity Paradox ◽

Overweight And Obesity ◽

Cardiac Resynchronization ◽

All Cause Mortality

Abstract Objective To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death. Methods A total of 782 patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators in the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-Implantable Patients registry were retrospectively analyzed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5 ≤ BMI < 25) and overweight or class I obesity (25 ≤ BMI < 35). PA was measured with home monitoring and categorized into 4 groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality. Results During a mean follow-up period of 59.9 ± 21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P = 0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P < 0.001). Multivariate Cox analysis indicated BMI (hazard ratio, 0.918; 95% confidence interval, 0.866-0.974; P = 0.004) and PA (0.436, 0.301-0.631, Q2 vs Q1; 0.280, 0.181-0.431, Q3 vs Q1; 0.257, 0.158-0.419, Q4 vs Q1; P < 0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P = 0.049) and low PA group (log rank P = 0.010), but disappeared in the high PA group (log rank P = 0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups. Conclusions The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.

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