Perspective:

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.