Sport Participation in Patients with Implantable Cardioverter-Defibrillators

  • Rachel LampertEmail author
Sports Cardiology (M Wasfy, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sports Cardiology


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.

Recent findings

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”.


Sports Implantable-cardioverter-defibrillator 


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

  1. 1.
    Colivicchi F, Ammirati F, Santini M. Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J. 2004;25:1749–53.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED use in sports. Br J Sports Med. 2013;47:1179–83.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 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. 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
  5. 5.
    Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, et al. Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I institutions. Br J Sports Med. 2013;47:182–4.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Miars CW, Stamatis A, Morgan GB, Drezner JA. Cardiovascular screening practices and attitudes from the NCAA autonomous "power" 5 conferences. Sports & Health. 2018;10:547–51.CrossRefGoogle Scholar
  7. 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. 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
  9. 9.
    Lampert R, Cannom D. Sports participation for athletes with implantable cardioverter-defibrillators should be an individualized risk-benefit decision. Heart Rhythm. 2008;5:861–3.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Maron BJ, Zipes DP. 36th Bethesda conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol. 2005;45:1313–75.CrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Sousa J, Kou W, Calkins H, Rosenheck S, Kadish A, Morady F. Effect of epinephrine on the efficacy of the internal cardioverter-defibrillator. Am J Cardiol. 1992;69:509–12.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Medbo JI, Sejersted OM. Plasma potassium changes with high intensity exercise. J Physiol. 1990;421:105–22.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    McAllister DR, Motamedi AR, Hame SL, Shapiro MS, Dorey FJ. Quality of life assessment in elite collegiate athletes. Am J Sports Med. 2001;29:806–10.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Rahman B, Macciocca I, Sahhar M, Kamberi S, Connell V, Duncan RE. Adolescents with implantable cardioverter defibrillators: a patient and parent perspective. Pacing Clin Electrophysiol. 2012;35:62–72.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Lampert R, Cannom D, Olshansky B. Safety of sports participation in patients with implantable cardioverter-defibrillators: a survey of Heart Rhythm Society members. J Cardiovasc Electrophysiol. 2006;17:11–5.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry. Circulation. 2013;127:2021–30.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 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. 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
  21. 21.
    Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of life in the antiarrhythmics versus implantable defibrillators. Circulation. 2002;105:589–94.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 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. 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. 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
  25. 25.
    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:2275–83.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593–601.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Toresdahl BG, Rao AL, Harmon KG, Drezner JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm. 2014;11:1190–4.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Johnson JN, Ackerman MJ. Competitive sports participation in athletes with congenital long QT syndrome. JAMA. 2012;308:764–5.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 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. 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. 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. This subanalysis looks at the incidence of shocks in a recreational cohort compared with athletes.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Maron BJ. The paradox of exercise. N Engl J Med. 2000;343:1409–10.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Lampert R, Soufer R, McPherson CA, Batsford WP, Tirado S, Earley C, et al. Implantable cardioverter-defibrillator shocks increase T-wave alternans. J Cardiovasc Electrophysiol. 2007;18:512–7.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Kirchhof P, Fabritz L, Zwiener M, Witt H, Schäfers M, Zellerhoff S, et al. Age- and training-dependent development of arrhythmogenic right ventricular cardiomyopathy in heterozygous plakoglobin-deficient mice. Circulation. 2006;114:1799–806.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Cruz FM, Sanz-Rosa D, Roche-Molina M, García-Prieto J, García-Ruiz JM, Pizarro G, et al. Exercise triggers ARVC phenotype in mice expressing a disease-causing mutated version of human Plakophilin-2. J Am Coll Cardiol. 2015;65:1438–50.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 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
  37. 37.
    Rojas A, Calkins H. Present understandingoftherelationship between exercise andarrhythmogenicrightventricular dysplasia/cardiomyopathy. Trends in Cardiovascular Medicine. 2015;25:181–8.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Konhilas JP, Watson PA, Maass A, Boucek DM, Horn T, Stauffer BL, et al. Exercise can prevent and reverse the severity of hypertrophic cardiomyopathy. Circ Res. 2006;98:540–8.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Saberi S, Wheeler M, Bragg-Gresham J, Hornsby W, Agarwal PP, Attili A, et al. Effect of moderate-intensity exercise training on peak oxygen consumption in patients with hypertrophic cardiomyopathy: a randomized clinical trial. JAMA. 2017;317:1349–57.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Sy RW, Gollob MH, Klein GJ, Yee R, Skanes AC, Gula LJ, et al. Arrhythmia characterization and long-term outcomes in catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm. 2011;8:864–71.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Ostby SA, Bos JM, Owen HJ, Wackel PL, Cannon B, Ackerman MJ. Competitive sports participation in patients with Catecholaminergic polymorphic ventricular tachycardia. JACC. Clinical Electrophysiology. 2016;2:253–62.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 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
  43. 43.
    Weiss R, Knight BP, Gold MR, Leon AR, Herre JM, Hood M, et al. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation. 2013;128:944–53.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, et al. Long-term outcome after ICD and CRT implant and the influence of remote device follow-up: the ALTITUDE survival study. Circulation. 2010;122:2359–67.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 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
  46. 46.
    Jacobs DM, Fink AS, Miller RP, Anderson WR, McVenes RD, Lessar JF, et al. Anatomical and morphological evaluation of pacemaker lead compression. Pacing Clin Electrophysiol. 1993;16:434–44.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 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
  48. 48.
    Etheridge SP, Saarel EV, Martinez MW. Exercise participation and shared decision-making in patients with inherited channelopathies and cardiomyopathies. Heart Rhythm. 2018;15:915–20.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Drezner JA. Detect, manage, inform: a paradigm shift in the care of athletes with cardiac disorders? Br J Sports Med. 2013;47:4–5.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Levine BD, Stray-Gundersen J. The medical care of competitive athletes: the role of the physician and individual assumption of risk. Med Sci Sports Exerc. 1994;26:1190–2.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Maron BJ, Mitten MJ, Quandt EF, Zipes DP. Competitive athletes with cardiovascular disease--the case of Nicholas Knapp. N Engl J Med. 1998;339:1632–5.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Barry MJ, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012;366:780–1.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Yale School of Medicine, Section of Cardiovascular MedicineNew HavenUSA

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