Many athletes with ICDs can still play sports
MedWire News: Patients with implantable cardioverter defibrillators (ICDs) have been discouraged from taking part in active sports by many cardiologists, but new research shows that athletes with ICDs may be able to play safely without fear of inappropriate shocks or other adverse events.
In all, 10%of high school, college and adult amateur athletes with ICDs reported receiving an ICD shock during play or practice, but no serious adverse events occurred, Rachel Lampert (Yale University School of Medicine, New Haven, Connecticut) and co-investigators found.
A total of 372 athletes, with a median age 33 years (range 10‑60 years), primarily male and Caucasian, were enrolled in an international registry of patients with ICDs. The devices were prescribed for primary cardiac diagnoses, including long QT syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and coronary artery disease.
Competitive sports they took part in included running, basketball, and soccer.. Dangerous sports, defined by investigators as any sport in which loss of control could injury, included skiing/snowboarding and cycling.
Two patients died during a median 31 months of follow-up: a 34-year-old volleyball/basketball player with familial cardiomyopathy who died in hospital from congestive heart failure, and a 52-year-old cyclist with coronary artery disease who died at his desk at work after receiving multiple shocks.
Nine patients were lost to follow-up, but all were confirmed to be alive at the time of the analysis. Additionally, six withdrew from the study and four developed worsening cardiac or medical conditions that prevented participating in sports, leaving 351 for the analysis.
There were no occurrences of either of the two primary endpoints: death or resuscitated arrest, or arrhythmia- or shock-related injury occurring during sports.
Overall, 77 patients (22%) received at least one shock during the study, 37 (10%) during sports. Four of these patients (1%) stopped sports completely following shocks, and seven (2%) stopped participating in one or more sport.
Eight ventricular arrhythmias occurred in seven athletes. The arrhythmias, which required 2‑6 shocks to terminate the event, occurred in patients who had either catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, or coronary artery disease.
Lead malfunctions had occurred in 3% of patients at 5-year follow-up, and 10% at 10 years. Definite lead malfunctions, defined as noise on a lead or change in pacing parameters with a visualized lead abnormality, occurred in 13 patients, and 14 had probable lead malfunctions, defined as a change in pacing function only.
"Shocks were not rare during sports. However, no serious health consequences occurred. Most patients returned to sports having received shocks while playing, implying that the negative impact on quality of life of the shocks was offset for them on the quality of life from sports participation," Lampert said.
By Neil Osterweil