Relationship between activity and sleep, as measured through a wearable accelerometer, and appropriate cardioverter defibrillator interventions: a prospective SafeHeart substudy

Physical activity has shown association with ventricular arrhythmia, however, the role of specific behavioral patterns over a 24 h cycle remains unknown. Therefore, we aimed to explore associations between physical behavior and appropriate implantable cardioverter defibrillator (ICD) therapy. We included patients with an ICD at two European sites, who wore wrist-based accelerometers capturing 24 h movement and sleep behaviours for 28 days. Behavioural measures included activity volume, duration and intensity, sleep duration, and efficiency. Participants were followed for 12 months for the outcome of appropriate ICD therapy. Cox proportional hazard models with restricted cubic splines were used for the analysis. Lastly, the predictive capacity was tested. A total of 253 ICD patients were included (mean age 63.5 (±10.2), 48 (19.0%) female). During follow-up, 40 participants (15.8%) received appropriate ICD therapy; 32 anti-tachycardia pacing (ATP) only (12.6%), 5 shock only (2.0%), and 3 combined ATP and shock (1.2%). In the adjusted model, high inactive duration (HR 1.40 (95% 1.10-1.78)), peak walking cadence (HR 1.07 (95% 1.03-1.12)), and total sleep duration (HR 1.50 (1.02-2.22)) were associated with the outcome. The dose-response relationship was U-shaped for inactive duration with a cut-off at 16 h, and linear for peak cadence and sleep. The prediction model reached an area under the receiver operating characteristic curve of 0.70 ± 0.03, with highest accuracy in the first months. Wearable-derived 24 h movement and sleep behaviours collected over 28 days were associated with later appropriate ICD therapy risk. Testing of the predictive value of digital biomarkers for enhanced risk stratification of ventricular arrhythmia warrants larger prospective studies. National Trial Registration (NL9218, http://onderzoekmetmensen.nl/).