U ntil 2015, consensus statements 1,2 advised against sports participation more vigorous than golf for patients with implantable cardioverter-defibrillators (ICDs) because of the postulated risks of death caused by failure to defibrillate, injury resulting from arrhythmia-related syncope or shock, or device damage. The multinational, prospective, observational ICD Sports Safety Registry quantified risks associated with sports participation for athletes receiving ICDs on the basis of standard criteria. Initial results (2013 3 ) demonstrated no death, failure to defibrillate, or injury resulting from arrhythmia or shock during sports. On the basis of these data, the 2015 eligibility and disqualification recommendations for competitive athletes with cardiovascular disease 4 now state that competitive sports may be considered for athletes with ICDs. This report describes 4-year follow-up of the completed registry. Methods are as reported previously.3 The Yale University Human Investigation Committee approved the study. All participants gave written informed consent.Among 440 participants, 393 in organized sports and 47 in high-risk sports, the most common diagnoses were long-QT syndrome (n=87, 20%), hypertrophic cardiomyopathy (n=75, 17%), and arrhythmogenic right ventricular cardiomyopathy (n=55, 13%). Of 201 subjects with a preimplantation history of ventricular fibrillation (VF) or tachycardia (VT), 61 (30%) had VT/VF during sports. At enrollment, median time since implantation was 26 months (interquartile range, 11-59 months), with 126 subjects (29%) enrolled within 1 year of implantation. The most common organized sports were running, basketball, and soccer; the most common dangerous sport was skiing. Seventy-seven subjects (18%) engaged in varsity/junior varsity/ traveling team competition, (highly competitive subgroup). Seventy-two postcollege athletes (16%) participated at a national/international level.Median follow-up was 44 months (interquartile range, 30-48 months), totaling 1446 person-years. Thirty-seven participants did not complete the study: 20 were lost to follow-up (all confirmed alive), 5 withdrew, 6 developed worsening cardiac/ medical conditions, 4 had the ICD removed, and 2 died (neither death was sports related, as reported previously 3 ). There were no tachyarrhythmic deaths or externally resuscitated tachyarrhythmias during or after sports participation or injury resulting from arrhythmia-related syncope or shock during sports. The 95% confidence interval for the occurrence of adverse event based on 376 participants followed up at least 2 years was 0% to 0.9% and based on 167 participants followed up at least 4 years was 0% to 2.2%.The numbers and rhythms of shocks received for the overall group and the highly competitive subgroup are shown in the Table. Forty-six (10%) received appropriate shocks (for VT/VF) during competition or practice, a rate of 3 per 100 person-years (identical to the initial report 3 ). More participants received shocks during competition/ practice or physical a...

Background: Despite safety concerns, many young patients with implantable cardioverter-defibrillators (ICDs) participate in sports. We undertook a prospective, multinational registry to determine the incidence of serious adverse events because of sports participation. The primary end points were death or resuscitated arrest during sports or injury during sports because of arrhythmia or shock. Secondary end points included system malfunction and incidence of ventricular arrhythmias requiring multiple shocks for termination. Methods: Athletes with ICDs aged ≤21 years were included in this post hoc subanalysis of the ICD Sports Registry. Data on sports and clinical outcomes were obtained by phone interview and medical records review. ICD shocks and clinical details of lead malfunction were classified by 2 electrophysiologists. Results: A total of 129 young athletes participating in competitive (n=117) or dangerous (n=12) sports were enrolled. The mean age was 16 years (range, 10–21; 40% female; 92% white). The most common diagnoses were long QT syndrome (n=49), hypertrophic cardiomyopathy (n=30), and congenital heart disease (n=16). The most common sports were basketball and soccer, including 79 varsity/junior varsity high school and college athletes. During a median follow-up of 42 months, 35 athletes (27%) received 38 shocks. There were no occurrences of death, arrest, or injury related to arrhythmia, during sports. There was 1 ventricular tachycardia/ventricular fibrillation storm during competition. Freedom from lead malfunction was 92.3% at 5 years and 79.6% at 10 years. Conclusions: Although shocks related to competition/practice are not uncommon, there were no serious adverse sequelae. Lead malfunction rates were similar to previously reported in unselected pediatric ICD populations. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00637754.