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Sport bei Schrittmacherpatienten

Sport for pacemaker patients

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Sport ist bei vielen Patienten mit Herzschrittmacher von Bedeutung, weil sie vor Schrittmacherimplantation sportlich aktiv waren, durch Sport ihr kardiovaskuläres Risiko reduzieren oder bei zugrunde liegender Herzerkrankung (koronare Herzerkrankung, Herzinsuffizienz) den Krankheitsverlauf verbessern können. Im Vergleich zu Patienten mit einem implantierten Defibrillator ist das Risiko für Probleme seitens kardialer Grunderkrankung (Ischämie, Herzinsuffizienz), Arrhythmien und Elektrodendefekten bei sportlicher Belastung niedriger bzw. nicht vorhanden (inadäquate Therapien). Sport ist kontraindiziert bei Ruhedyspnoe, akuter kardialer Dekompensation, komplexen ungeklärten Arrhythmien, akuter Myokarditis, frischem Myokardinfarkt, hochgradigen Klappenvitien und Komorbidität, die körperliche Belastung verhindert.

Schrittmacherpatienten mit kardiovaskulärer Grunderkrankung (inkl. Hypertonie) sollten aerobe Sportarten mit hohem dynamischem Anteil (z. B. Laufen, Schwimmen, Radfahren) anaerober Belastung und hohen muskulären Anforderungen vorziehen. Bei Herzinsuffizienz zeigen Studien einen Vorteil für Sport mit Kräftigung der Muskulatur, da hierdurch einer kardialen Kachexie vorgebeugt wird. Sportarten mit hoher Wahrscheinlichkeit für Schläge auf den Brustkorb oder Kollision (z. B. Boxen, Rugby, Kampfsport) sollten vermieden werden. Bei Implantation (nichtbelastete Seite, bipolare Elektroden), Programmierung (Sensor- und obere Grenzfrequenz) und Nachsorge (regelmäßige Ergometrie) sollte auf eine optimale Sportfähigkeit unter Schrittmachertherapie geachtet werden.

Abstract

Sport activity is an important issue in many patients with a pacemaker either because they performed sport activities before pacemaker implantation to reduce the cardiovascular risk or to improve the course of an underlying cardiovascular disease (e.g. coronary artery disease, heart failure) by sports. Compared to patients with an implantable cardioverter defibrillator (ICD) the risks from underlying cardiovascular disease (e.g. ischemia, heart failure), arrhythmia, lead dysfunction or inappropriate therapy are less important or absent. Sport is contraindicated in dyspnea at rest, acute heart failure, new complex arrhythmia, acute myocarditis and acute myocardial infarction, valvular disease with indications for intervention and surgery and comorbidities which prevent physical activity.

Patients with underlying cardiovascular disease (including hypertension) should preferably perform types and levels of physical activity that are aerobic (with dynamic exercise) such as running, swimming, cycling instead of sport with high anaerobic demands and high muscular workload. In heart failure, studies demonstrated advantages of isometric sport that increases the amount of muscle, thereby preventing cardiac cachexia. Sport with a risk of blows to the chest or physical contact (e.g. boxing, rugby, martial arts) should be avoided. Implantation, programming and follow-up should respect specific precautions to allow optimal physical activity with a pacemaker including implantation of bipolar leads on the side contralateral to the dominant hand, individual programming of the upper sensor and tracking rate and regular exercise testing.

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  1. Klinik für Innere Medizin – Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland

    C.W. Israel

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Israel, C. Sport bei Schrittmacherpatienten. Herzschr. Elektrophys. 23, 94–106 (2012). https://doi.org/10.1007/s00399-012-0183-0

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