Journal Wrap: Heartening News for Athletes with ICDs

Despite current ACC and ESC guidelines recommendations that patients with implantable cardioverter-defibrillators (ICDs) refrain from participating in competitive sports, more than 40% of physicians reported having at least one ICD patient participating in sports without serious adverse events, according to a Heart Rhythm Society survey. In an effort to assist physicians and ICD patients in making informed decisions regarding sports participation, Rachel Lampert, MD, and colleagues analyzed data from the ICD Sports Safety Registry—a multinational, prospective, observational registry established to identify and quantify risks experienced by athletes with ICDs.

The analysis included 372 patients (ages 10–60 years) participating in either organized (n = 328) or high-risk (n = 44) sports; data about sports participation, ICD shocks, and clinical outcomes were collected every 6 months for an average of 2.5 years. Running, basketball, and soccer were the most common sports, and 60 of the patients were competitive athletes.

During follow-up, there were no occurrences of the primary endpoints (death, resuscitated arrest, and arrhythmia- or shock-related injury) during sports. There were 49 shocks in 37 participants, equivalent to 10% of the study population, and the majority of shocks occurred during physical activity.

Among the 64 appropriate shock episodes, eight required multiple shocks for arrhythmia termination: one at rest, four during competition/practice, and three during other physical activity. Ultimately, the ICD terminated all episodes. These occurred in seven patients who had existing tachycardias or CAD, though, suggesting that special consideration be paid to these higher-risk patients. System malfunction with the devices was low—13 definite lead malfunctions, but freedom from lead malfunction was 97% at 5 years (from implantation) and 90% at 10 years.

"Challenging conventional wisdom, this prospective study is the first to show that many athletes with ICDs can engage in sports without physical injury or failure to terminate the arrhythmia," Dr. Lampert and colleagues wrote, adding that the data do not prove that there is no risk when an at-risk athlete participates in sports, but that a blanket warning against competitive sports for ICD patients is unwarranted.

Lampert R, Oshansky B, Heidbuchel H, et al. Circulation. 2013;127:2021-30.

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