Participation in Sports Appears Safe for Most Athletes with Implantable Cardioverter Defibrillators

EBM Focus - Volume 8, Issue 22

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Reference: Circulation 2013 May 21;127(20):2021

Recommendations from the American College of Cardiology and the European Society for Cardiology caution against participation in vigorous sports in patients with implantable cardioverter defibrillators (ICDs) (J Am Coll Cardiol 2005 Apr 19;45(8):1318, Eur J Cardiovasc Prev Rehabil 2006 Oct;13(5):676). These recommendations have largely been based upon projected risks for adverse events, since little data have been available to assess the actual risks. A recent cohort study followed 372 athletes with ICDs in place who were participating in vigorous sports.

Participants, who ranged in age from 10 to 60 years old (median age 33 years with ICD for median 27 months), were assessed every 6 months during median follow-up of 31 months. 88% of the participants were active in organized sports that included regular practices and competitions with vigorous physical activity (most common sports were running, basketball, and soccer). The others participated in “high-risk” sports (e.g. skiing or surfing) in which injury could result from loss of control. The most common cardiac diagnoses were long QT syndrome (in 20%) and hypertrophic cardiac myopathy (in 17%), and the most common indications for ICD were ventricular fibrillation or cardiac arrest (in 27%) and syncope (in 27%). The primary outcome was serious adverse events during sports or within 2 hours of sports activity. These events included death or externally resuscitated tachyarrhythmia caused by shock failure, incessant ventricular arrhythmia, or pulseless electric activity after shock, and severe injury from shock or from arrhythmia-related syncope that required hospitalization.

There were no primary outcome events during follow-up. Overall, 21% of participants had at least 1 ICD shock, with appropriate shocks in 13% and inappropriate shocks in 11%. The rate of shocks during activity (in 10% during competition or practice and in 8% during other physical activity) were significantly higher than during rest (6%, p < 0.0001). In a subgroup of 60 school and college age competitive athletes, 2 athletes stopped or limited further sports activity on advice from their physicians following shocks during competition or practice. Definite lead malfunction occurred in 13 ICDs, with an estimated 5-year malfunction-free survival of 97%, a rate reported to be similar to that in unselected populations. These data may help inform discussions between clinicians and patients with ICDs who wish to participate in sports.

For more information, see the Implantable cardioverter defibrillator (ICD) topic in DynaMed.