Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators

Abstract

Background-The risks of sports participation for implantable cardioverter-defibrillator (ICD) patients are unknown. Methods and Results-Athletes with ICDs (age, 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 records. Follow-up occurred every 6 months. ICD shock data and clinical outcomes were adjudicated by 2 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 end point-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 8 ventricular arrhythmia episodes (device defined), multiple shocks were received: 1 at rest, 4 during competition/practice, and 3 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. Conclusions-Many athletes with ICDs can engage in vigorous and competitive sports without physical injury or failure to terminate the 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.

Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators

“…3 In conclusion, in longer-term follow-up of the ICD Sports Registry, athletes with ICDs engaged in vigorous competitive sports without physical injury or failure to terminate arrhythmia, despite the occurrence of inappropriate and appropriate shocks in some. Underlying disease should be considered, in particular arrhythmogenic right ventricular cardiomyopathy, because exercise increases disease progression 5 and arrhythmia.…”

“…The rate of arrhythmias requiring multiple shocks for termination was 0.5 per 100 person-years, similar to the previously reported 0.4 per 100 person-years. 3 Among all appropriate shock episodes occurring during competition/practice, 23% required multiple shocks for termination versus 15% during other physical activity and 11% during rest (P=NS). Among the 12 participants experiencing multiple shocks during competition/physical activity, 3 (of 45) had coronary artery disease, 3 (of 48) had idiopathic VF, 3 (of 55) had arrhythmogenic right ventricular cardiomyopathy, and 1 each had CPVT (of 12), dilated cardiomyopathy (of 35), and sarcoidosis (of 1).…”

“…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.…”

“…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 activity than rest (20% versus 10%; P<0.0001), but the proportion receiving a shock during competition/practice was similar to the proportion receiving a shock during other physical activity (12% versus 10%; P=0.56).…”

“…3 The Yale University Human Investigation Committee approved the study. All participants gave written informed consent.…”