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Exercise in Specific Diseases: Pacemakers and Implantable Cardioverter Defibrillators

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Textbook of Sports and Exercise Cardiology

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Abstract

Expanding guidelines and improved diagnostic/screening techniques have led to an ever-increasing pool of subjects with cardiac implanted electronic devices (CIEDs), including a significant proportion who are young and physically active. Exercise has multiple health benefits, both physical and psychological, and a structured rehabilitation program is advocated for most patients with heart disease. However, the presence of a CIED such as a pacemaker or cardiac defibrillator (ICD) gives rise to specific concerns with regard to exercise, including increased risk for arrhythmia occurrence, syncope, physical injury, appropriate and inappropriate shocks, and device malfunction/damage related to trauma. While high intensity exercise and competitive sports are considered inadvisable in this situation, available evidence suggests that moderate to strenuous exercise and recreational sports can be practiced safely in most individuals. This chapter discusses the main issues with regard to exercise in patients with CIEDs, summarizes available evidence on this topic and aims to provide a practical framework for decision-making for the clinician confronted with this problem.

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Author information

Authors and Affiliations

  1. Paris Cardiovascular Research Center, Inserm U970, Paris, France

    Kumar Narayanan & Eloi Marijon

  2. Cardiology Department, Medicover Hospitals, Hyderabad, India

    Kumar Narayanan

  3. Cardiology Department, European Georges Pompidou Hospital, Paris, France

    Eloi Marijon

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  1. Kumar Narayanan
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Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    A 20-year-old college student implanted with an ICD seeks advice on participating in leisure time sports. Which of the following conditions would be most concerning for disease progression due to exercise?

    1. (a)

      Long QT Syndrome

    2. (b)

      Brugada Syndrome

    3. (c)

      Arrhythmogenic Right Ventricular Cardiomyopathy

    4. (d)

      Repaired Tetralogy of Fallot

  2. 2.

    Guidelines on exercise in patients with ICDs recommend which of the following:

    1. (a)

      Participation in impact sports.

    2. (b)

      Waiting for an arrhythmia-free period of at least 3 months before vigorous exercise.

    3. (c)

      Strictly no exercise for all secondary prevention ICD recipients.

    4. (d)

      Psychological evaluation before starting exercise.

1.2 Answers

  1. 1.

    (c) Studies have shown that patients with ARVC have a particularly high risk of disease progression due to exercise, with resultant increase in likelihood of malignant arrhythmic events. Even in asymptomatic genetic mutation carriers, exercise has been shown to promote conversion to overt disease with an increased rate of clinical events. Hence in ARVC, greater caution is warranted with respect to vigorous exercise and sports. The other listed conditions do not have a risk of underlying disease progression due to exercise as such.

  2. 2.

    (b) As per guidelines for patients with ICDs, it is recommended to wait for an arrhythmia/shock free period of at least 3 months before participating in vigorous exercise. This potentially reduces the likelihood of arrhythmia or shocks during renewed exercise and also gives an opportunity to optimize anti-arrhythmic drugs and overall management to minimize the risk of future events. Participation in sports with risk of impact or collision is not advisable in CIED patients. Although, ongoing psychosocial support can be useful as part of an exercise rehabilitation program for CIED patients, formal psychological evaluation is not mandatory before allowing exercise. Lastly, there is no recommendation disallowing exercise for secondary prevention ICD recipients.

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Narayanan, K., Marijon, E. (2020). Exercise in Specific Diseases: Pacemakers and Implantable Cardioverter Defibrillators. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_50

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