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Safety of Sports for Athletes With ICDs
Study Questions:
What are the risks of sudden death, implantable cardioverter-defibrillator (ICD) shocks, and other complications in athletes with ICDs?
Methods:
This was an analysis of the multinational, prospective, observational ICD Sports Safety Registry. An interim analysis was published in 2015. The current work extends the analysis by providing longer follow-up.
Results:
There were 440 participants, 47 of whom participated in high-risk sports. The most common diagnoses were long QT syndrome (n = 87), hypertrophic cardiomyopathy (n = 75), and arrhythmogenic right ventricular cardiomyopathy (ARVC; n = 55). Median follow-up was 44 months, totaling 1,446 person-years. Of 201 subjects with a pre-implant history of ventricular fibrillation (VF) or tachycardia (VT), 61 (30%) had VT/VF during sports. There were no tachyarrhythmic deaths or externally resuscitated tachyarrhythmias during or after sports participation, or injury due to arrhythmia-related syncope and/or shock during sports. More participants received shocks during competition/practice or physical activity than rest (20% vs. 10%, p < 0.0001), but the proportion receiving a shock during competition/practice was similar to other physical activity (12% vs. 10%, p = 0.56). The only clinical or demographic variable associated with receiving appropriate shocks during competition/practice was presence of ARVC.
Conclusions:
Athletes with ICDs engaging in vigorous competitive sports do not suffer physical injury or failure to terminate arrhythmia, despite occurrence of inappropriate and appropriate shocks in some.
Perspective:
Older American and European consensus documents on competitive sports participation in athletes with ICDs recommended that they should limit sports to class IA–level activities. Examples of those activities include billiards, bowling, cricket, curling, golf, and riflery. These highly restrictive guidelines were based on reasoned notions in the absence of observational data, and reflected concerns about the reliability of device therapy, the possibility of device malfunction, and the risk of injury to the athlete or damage to the device by trauma. However, based on emerging observational data, a 2015 American College of Cardiology/American Heart Association Scientific Statement allowed for participation in sports with higher peak static and dynamic components than Class IA if the athlete is free of episodes of ventricular flutter or VF requiring device therapy for 3 months (Class IIb, Level of Evidence C). The present report’s findings are largely congruent with and provide additional support for this recommendation.
Keywords: Arrhythmias, Cardiac, Arrhythmogenic Right Ventricular Dysplasia, Athletes, Cardiomyopathy, Hypertrophic, Death, Sudden, Defibrillators, Implantable, Exercise, Heart Defects, Congenital, Heart Failure, Long QT Syndrome, Secondary Prevention, Sports, Syncope, Tachycardia, Ventricular Fibrillation, Ventricular Flutter
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