The Crucial Role of Physical Activity Index, in Predicting the Incidence of Pacemaker Syndrome

While AV dyssynchrony is present in all cases with a single-chamber pacemaker, pacemaker syndrome (PMS) occurs in only a minority of patients. This study aims to investigate the role of physical activity in the incidence of this syndrome.

Physical activity data of 200 patients receiving a dual-chamber pacemaker were obtained from the International Physical Activity Questionnaires. They were divided into two groups: Group A with a physical activity level of less than 500 MET-min/week, and Group B with a higher level. After switching to VVIR mode at discharge, patients were followed for 6 months to monitor the development of pacemaker syndrome.

Forty-seven cases of PMS were recorded, representing an incidence rate of 23%. Group B had significantly more PMS cases than Group A (33 vs. 14, p = 0.002). There were no significant differences in the prevalence of coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and smoking between the two groups. However, hypertension and hypercholesterolemia were more prevalent in Group A. The receiver operating characteristic curve analysis revealed a cut-off value of 339 MET-min/week, with a sensitivity of 97.8% and a negative predictive value of 98% for predicting PMS occurrence. The area under the curve was 0.713 (p < 0.001, 95% CI: 0.65-0.77).

A physical activity level below 399 MET-min/week can predict the non-occurrence of PMS with a 98% predictive value. This can help physicians identify patients less likely to develop symptoms.