Actividad física y taquicardias ventriculares no sostenidas de frecuencia rápida en pacientes con miocardiopatía arritmogénica

Abstract

In Arrhythmogenic Cardiomyopathy (AC) patients, competitive sports participation and regular exercise of moderate to vigorous intensity (measured by self-reported questionnaires) has been associated with a worsened prognosis, increasing the arrhythmic risk and leading to an adverse structural remodeling and an impaired ventricular function. However the effects of lifestyle physical activity (PA) (objectively measured by accelerometers) on the arrhythmic risk and the structural remodeling has never been studied. The main hypothesis of this doctoral thesis is that patients with AC who engage in more PA will have a higher odds of presenting rapid-rate non-sustained ventricular tachycardias (RR-NSVT) defined as a non sustained ventricular tachycardia with a heart rate >188 bpm and >18 beats. Additionally, it is postulated that patients with AC will have insufficient levels of PA, high levels of sedentary behavior, and inadequate sleep. And that the measurement of PA evaluated on a weekly basis will remain stable for a period of four weeks. The aims of this doctoral thesis were: 1. To describe the patterns of PA, sedentary time and sleep in patients with AC and to examine the reproducibility of accelerometer-derived measures over four consecutive weeks. 2. To investigate the association of accelerometer-measured lifestyle PA with RR-NSVTs in patients with AC. Methods This multicentre, observational study enrolled 71 patients with AC diagnosed by 2020 Padua Criteria including right, left and biventricular forms of the disease, with underlying desmosomal and non-desmosomal mutations. Every patient wore a wrist-worn Axivity AX3 accelerometer for 30 consecutive days to monitor their PA, SED, and sleep habits. The reproducibility of each metric across the 4 assessment weeks was assessed with the intraclass correlation coefficients. A total of 63 of these 71 patients also wore a textile Holter-ECG Nuubo, for 30 days to identify RR-NSVT and to investigate the association of PA with the latter. Results 1. To describe the patterns of PA, sedentary time and sleep in patients with AC and to examine the reproducibility of accelerometer-derived measures over four consecutive weeks: - 71 participants (n=36, 50,7% women) were included to respond this objective. They spent a median of 12.2 [IQR 2.1] hours per day in sedentary time, 6.4 [IQR 1.0] hours per day sleeping, and 17.9 [IQR 24.5] minutes per day in moderate-to-vigorous PA and 59% of the participants did not reach the 150 minutes per day of moderate-tovigorous PA recommended by the WHO for people living with chronic diseases. Patients aged ≥50 years (n= 33) spent 38.9 minutes per day (95% CI 5.8 to 72.2, p≤0.05) more in periods of ≥30 minutes of sedentary time than those <50 years. Participants with obesity (n=10) accumulated 66.6 minutes per day (95% CI 5.2 to 128.1, p = <0.05) more sedentary time in periods of ≥30 minutes and 22.8 minutes per day (95% CI 0.7 to 44.9, p≤0.05) less moderate-to-vigorous PA than those without obesity. The intraclass correlation coefficients between weeks were 0,66 for time in bed, 0,90 for sedentary time, 0,92 for light-intensity PA and 0,77 for moderateto- vigorous PA. 2. To investigate the association of accelerometer-measured lifestyle PA with RR-NSVTs in patients with AC: - 63 of these 71 patients (38±17.6 years, 57% men) were included to respond this objective. A total of 17 patients experienced ≥1 RR-NSVTs, and a total of 35 events were recorded. The odds of occurrence of ≥1 RR-NSVT during the recording did not increase as a function of either total PA (OR 0.95, CI95% 0.68 to 1.30 for 60 minutes increase) or moderate-to-vigorous PA (OR 0.89, CI95% 0.71 to 1.08 for 5 minutes increase). Participants presenting RR-NSVTs during the recording (n=17) did not present greater odds of RR-NSVT in the days with more time either in total PA (OR 1.05, CI95% 0.84 to 1.29 for additional 60 min) or moderate-to-vigorous PA (OR 1.05, CI95% 0.97 to 1.12 for additional 5 min). PA levels were neither different between the patients with and without RR-NSVTs during the recording period nor in the days of occurrence of RR-NSVT compared with the rest of the days. Finally, 4 of the 35 RRNSVTs recorded in the 30 days occurred during PA (3 during moderate-to-vigorous PA and 1 during light-intensity activities). Conclusions 1. Patients with AC engage in large periods of sedentary time, insufficient PA and sleep. Importantly, nearly 60% of the participants did not meet the minimum amount of PA recommended by the WHO for people living with chronic diseases and only 20% met the sleep recommendations from American Academy of Sleep Medicine. Devicemeasured PA and sedentary time are stable across weeks, indicating that a 7-day assessment period might provide a reproducible measure of PA and sedentary time measurement although to achieve comparable stability in sleep measurement, a measurement period of 14 days may be necessary. 2. Our findings suggest that light or moderate PA in patients with AC does not increase the odds of experiencing RR-NSVT. PA levels were not different between patients with and without RR-NSVT. Patients with RR-NSVT displayed similar PA patterns on days with and without RR-NSVT and RR-NSVT rarely occurred during the performance of PA.