, et al
Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry
; doi:

Researchers from multiple institutions investigated the risks of sports participation for individuals with implantable cardioverter-defibrillators (ICDs) by analyzing data from a multinational, prospective, observational ICD Sports Safety Registry. Athletes with ICDs (aged 10 to 60 years) were recruited via their physicians and patient internet sites and mailing lists. Data were collected via phone interviews with enrolled participants every 6 months, and medical records were reviewed at 41 North American and 18 European study sites. Patients were queried about shocks received, sequelae, preshock activity, and any change in sports participation, health, or ICD status. The primary outcome was a serious adverse event during or up to 2 hours after sports. Secondary outcomes included shock episodes, moderate injury associated with a shock, and ICD lead damage.

Of the 372 participants, 328 were engaged in organized sports, and 44 in high-risk sports. Median age of participants was 33 years (89 participants <20 years of age); 33% were female. Sixty were competitive athletes. The most common diagnoses were long-QT syndrome (n=73), hypertrophic cardiomyopathy (n=63), and arrhythmogenic right ventricular cardiomyopathy (n=55). A pre-ICD history of ventricular arrhythmia was present in 42%. The most common organized sports were running, basketball, and soccer, and the most common high-risk sport was skiing.

Over a median 31-month (range, 21–46 months) follow-up, there were no deaths, resuscitated arrests, or arrhythmia-or shock-related injuries during sports. There were 49 shocks in 37 participants (10% of study population) during competition/practice, 39 shocks in 29 participants (8%) during other physical activity, and 33 shocks in 24 participants (6%) at rest. More individuals received shocks during either competition/practice or physical activity than during rest (16% vs 6%; P < .0001), but there was no difference between the proportion receiving a shock during competition/practice and those receiving a shock during other physical activity (10% vs 8%; P = .34). Of the 60 individuals <21 years of age participating in competitive athletics, 17 (28%) experienced a total of 25 shocks. There was no significant difference in the number of appropriate shocks between the competitive subgroup and those not in the competitive subgroup. Overall, 70% of those who received shocks during sports continued to participate. There was no history of lead malfunction in 97% of participants at 5 years (from implantation) and 90% at 10 years.

The authors conclude that many athletes with ICDs can engage in vigorous and competitive sports without physical injury or failure to terminate the arrhythmia despite the occurrence of both inappropriate and appropriate shocks.

Dr LaBella has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Consensus cardiologist opinion advises against sports participation more strenuous than bowling or golf for patients with ICDs due to concern...

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