Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators: Results of a Prospective, Multinational Registry
What are the risks of sports participation for patients with an implanted cardioverter-defibrillator (ICD)?
Athletes with an ICD (ages 10-60 years) participating in organized (n = 328) or high-risk (n = 44) sports were recruited. Sports-related and clinical data were obtained by phone interview and medical record review. Follow-up was every 6 months. Data regarding ICD shocks and clinical outcomes were adjudicated by two electrophysiologists.
Median age was 33 years (89 subjects <20 years of age); 33% were female. Sixty were competitive athletes (varsity/junior varsity/traveling team). A pre-ICD history of ventricular arrhythmia was present in 42%. Running, basketball, and soccer were the most common sports. Over a median 31-month (interquartile range, 21-46 months) follow-up, there were no occurrences of either primary endpoint––death or resuscitated arrest, or arrhythmia- or shock-related injury––during sports. There were 49 shocks in 37 participants (10% of study population) during competition/practice, 39 shocks in 29 participants (8%) during other physical activity, and 33 shocks in 24 participants (6%) at rest. In eight ventricular arrhythmia episodes (device defined), multiple shocks were received: one at rest, four during competition/practice, and three during other physical activity. Ultimately, the ICD terminated all episodes. Freedom from lead malfunction was 97% at 5 years (from implantation) and 90% at 10 years.
Many athletes with ICDs can engage in vigorous and competitive sports without physical injury or failure to terminate an arrhythmia despite the occurrence of both inappropriate and appropriate shocks. These data provide a basis for more informed physician and patient decision making in terms of sports participation for athletes with ICDs.
Consensus guidelines from the American College of Cardiology and American Heart Association suggest that athletes with cardiovascular conditions such as hypertrophic cardiomyopathy, who are at risk for potentially lethal ventricular arrhythmias, should not participate in any moderate- or high-intensity sport; and do not condone athletic participation based on the presence of an ICD. However, athletic activity has substantial physical and psychological benefits, and proscribing all but low-intensity physical activity has its own health risks. This registry report provides very important information. In a real-world setting, athletes with an ICD participated in both organized and high-risk sports. Although ICD discharges were encountered, adverse events including death, resuscitated arrest, and injuries related to arrhythmia or to shock did not occur. These data cannot be taken that there is no risk when an at-risk athlete participates in sports, or that an ICD fully mitigates all risk. But they are encouraging for opening the door to informed decision making by patients with an ICD regarding participation in athletics.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Exercise
Keywords: Physicians, Athletes, Risk, Follow-Up Studies, Shock, Cardiomyopathy, Hypertrophic, Sports, Running, Medical Records, Tachycardia, Ventricular, Soccer, Basketball, United States, Defibrillators, Implantable
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