Association between regular exercise and the risk of major adverse cardiovascular events in patients with pacemaker

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: The optimal amount of exercise for preventing cardiovascular events in patients with pacemakers has not been revealed. METHODS: Using the Korean National Health Insurance Service database, patients who had newly implanted pacemakers between 2009 and 2018 were included. The amount of physical activity was measured by a self-reported questionnaire included in the national health examination. Performing regular exercise was defined as ≥5 days of moderate-intensity exercise or ≥3 days of vigorous-intensity exercise per week. The occurrence of major adverse cardiovascular events (MACE) defined as the composite of stroke, heart failure, myocardial infarction, and all-cause death was evaluated during follow-up. RESULTS: A total of 13,542 patients were included (mean age 68±11 years, 45% of men); 51% of patients were atrioventricular block and 39% of patients were sick sinus syndrome, and 85% of patients were implanted with dual-chamber pacemaker. During a median 2.5-year of follow-up, the incidence rates of MACE was 5.4 and 3.7 per 100 person-years in non-exerciser and exerciser, respectively (Figure A). Compared to non-exerciser, patients performing regular exercise were associated with a lower risk of MACE (hazard ratio, 95% confidence interval: 0.745, 0.661-0.839, p<0.001, Figure B). Patients with ≥450 metabolic equivalents (METs) which was the highest quartile cut-off of exercise amount were significantly associated with a lower risk of MACE (0.765, 0.686-0.853, p<0.001) than patients with <450 METs. Compared to persistent non-exerciser before and after pacemaker implantation, persistent exercisers and exercise-starters showed a significantly lower risk of MACE (0.788, 0.662-0.938, p=0.007 and 0.584, 0.462-0.738, p<0.001, respectively, Figure C). CONCLUSION: Regular physical activity was related to the risk of MACE in patients with pacemaker. A proactive cardiac rehabilitation program would be considered for this population. [Figure: see text]