Sports competition can be safe with ICD

Athletes equipped with Automatic Implantable Defibrillators (ICDs) may be able to compete safely, although there may be appropriate and inappropriate shocks, according to longer-term follow-up from the registry which amended DCI guidelines for allow sport.

None of the 440 participants died or were resuscitated outdoors for a tachyarrhythmia during or after participation in sport during the median 44 months of follow-up. There were also no injuries from syncope or arrhythmia-related shock during sports, reported Rachel Lampert, MD, of Yale University in New Haven, Connecticut, and her colleagues in a report. research letter in Circulation.

The 95% confidence interval for the occurrence of adverse events over the full 4 years of follow-up was 0% to 2.2%.

The ICD’s multinational and forward-looking sports safety register included 393 athletes in organized sports (most commonly running, basketball or football) and 47 in high-risk sports (usually skiing). Their most common diagnoses were long QT syndrome (20%), hypertrophic cardiomyopathy (17%), and arrhythmogenic right ventricular cardiomyopathy (13%).

Ventricular fibrillation or tachycardia occurred during sports activities in 30% of 201 individuals with a history of these pre-DCI events. ICD shocks appropriate for such events occurred in 10% of participants during competition or training, at a rate of 3 per 100 person-years. These shocks were more frequent during physical activity than at rest (20% vs. 10%; PP= 0.56).

High competition sports did not differ from other sports, although arrhythmogenic right ventricular cardiomyopathy was a risk factor and related to multiple shocks.

“The underlying disease should be taken into account, especially arrhythmogenic right ventricular cardiomyopathy, as exercise increases disease progression and arrhythmia,” the researchers concluded. “These data may guide more informed individualized physician and patient decision making for athletic participation for athletes with ICD and continue to support the recent change in eligibility recommendations.”

Consensus documents once advised against more vigorous sports than golf for ICD recipients. After initial registry results showed no real risk of death, defibrillation failure, or injury from arrhythmia or shock during sports in these patients, the 2015 recommendations from the American Heart Association / American College of Cardiology for Competitive Athletes have changed to indicate that competitive sports can be considered for people with ICD.

Disclosures

The study was funded by grants initiated by researchers at Boston Scientific, Medtronic and St Jude Medical.

Lampert reported relationships with Boston Scientific, Medtronic, and St. Jude Medical.


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Sara R. Cicero