Sport Participation in Patients with Implantable Cardioverter-Defibrillators
- 29 Downloads
Purpose of review
Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf.
The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4 years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes.
Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, “may be considered”.
Compliance with Ethical Standards
Conflict of Interest
Rachel Lampert reports grants from Medtronic, St Jude/Abbott, and Boston Scientific.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance
- 3.Mont L, Pelliccia A, Sharma S, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19:139–63.PubMedCrossRefPubMedCentralGoogle Scholar
- 4.Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation. 2014;130:1303–34.PubMedCrossRefPubMedCentralGoogle Scholar
- 7.Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European heart rhythm association (EHRA). Heart Rhythm. 2011;8:1308–39.PubMedCrossRefPubMedCentralGoogle Scholar
- 8.Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in may 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10:1932–63.PubMedCrossRefPubMedCentralGoogle Scholar
- 11.Pelliccia A, Fagard R, Bjornstad HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the study Group of Sports Cardiology of the working Group of Cardiac Rehabilitation and Exercise Physiology and the working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:1422–45.PubMedCrossRefPubMedCentralGoogle Scholar
- 12.Heidbuchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, et al. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil. 2006;13:676–86.PubMedCrossRefPubMedCentralGoogle Scholar
- 19.•• Lampert R, Olshansky B, Heidbuchel H, et al. Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators: Long-Term Results of a Prospective Multinational Registry. Circulation. 2017;135:2310–2 This is the first study to collect prospective data on athletes with ICDs continuing to participate in sports.PubMedCrossRefPubMedCentralGoogle Scholar
- 20.Kramer DB, Maisel WH. Guidelines for managing pacemaker and implantable defibrillator advisories. In: Ellenbogen KA, editor. Clinical cardiac pacing, defibrillation, and resynchronization therapy. Philadelphia: Elsevier Saunders; 2011.Google Scholar
- 22.•• Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NA, 3rd. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015;132:e315–325. In this most recent consensus statement, sports participaton with an ICD is now a "IIB" recommendation, "may be considered"PubMedCrossRefPubMedCentralGoogle Scholar
- 23.• Saarel EV, Law I, Berul CI, et al. Safety of Sports for Young Patients With Implantable Cardioverter-Defibrillators. Circ Arrhythm Electrophysiol. 2018;11:e006305 This subanalysis describes the younger subpopulation of athletes in the ICD Sports Registry, including the interscholastic athletes.PubMedPubMedCentralGoogle Scholar
- 24.• Olshansky B, Atteya G, Cannom D, et al. Competitive athletes with implantable cardioverter defibrillators: how to program? Data from the implantable CardioverterDefibrillator sports registry. Heart Rhythm. 2019;16:581–7 This subanalysis describes results of subanalyses of programming in the ICD Sports Registry.PubMedCrossRefPubMedCentralGoogle Scholar
- 29.Aziz PF, Sweeten T, Vogel RL, Bonney WJ, Henderson J, Patel KR, et al. Sports participation in genotype positive children with long QT syndrome. JACC. Clinical Electrophysiology. 2015;1:62–70.Google Scholar
- 30.Pelliccia AMD, Lemme EMD, Maestrini VMD, Di Paolo FMMD, Pisicchio CMD, Di Gioia GMD, et al. Does sport participation worsen the clinical course of hypertrophic cardiomyopathy?: clinical outcome of hypertrophic cardiomyopathy in athletes. Circulation. 2018;137:531–3.PubMedCrossRefPubMedCentralGoogle Scholar
- 31.• Heidbuchel H, Willems R, Jordaens L, Olshansky B, Carre F, Lozano IF, et al. Intensive recreational athletes in the prospective multinational ICD sports safety registry: results from the European cohort. Eur J Prev Cardiol. 2019;26:764–75. https://doi.org/10.1177/2047487319834852. This subanalysis looks at the incidence of shocks in a recreational cohort compared with athletes.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.James CA, Bhonsale A, Tichnell C, Murra yB, Russell SD, Tandri H, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol. 2013;62(14):1290–7.PubMedCrossRefPubMedCentralGoogle Scholar
- 42.Burke MC, Gold MR, Knight BP, Barr CS, Theuns DAMJ, Boersma LVA, et al. Safety and efficacy of the totally subcutaneous implantable defibrillator: 2-year results from a pooled analysis of the IDE study and EFFORTLESS registry. J Am Coll Cardiol. 2015;65:1605–15.PubMedCrossRefPubMedCentralGoogle Scholar
- 45.Gold MR, Theuns DA, Knight BP, Sturdivant JL, Sanghera R, Ellenbogen KA, et al. Head-to-head comparison of arrhythmia discrimination performance of subcutaneous and transvenous ICD arrhythmia detection algorithms: the START study. J Cardiovasc Electrophysiol. 2012;23:359–66.PubMedCrossRefPubMedCentralGoogle Scholar
- 47.•• Baggish AL, Ackerman MJ, Lampert R. Competitive Sport Participation Among Athletes With Heart Disease: A Call for a Paradigm Shift in Decision Making. Circulation. 2017;136:1569–71 This "perspective" discusses the concept of shared decision-making and its importance in the return-to-play decision for athletes with cardiovascular disease.PubMedCrossRefPubMedCentralGoogle Scholar