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Sports participation for athletes with ICDs may be safer than thought
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In contrast with current recommendations, many patients with implantable cardioverter defibrillators may participate safely in a number of vigorous sports, according to study findings.
The American College of Cardiology and the European Society of Cardiology have consensus recommendations that those with ICDs should not participate in contact or vigorous sports; however, the frequency of adverse events that might occur had not been investigated. A group of investigators that included Rachel Lampert, MD, associate professor of medicine at Yale School of Medicine, found that the recommendations may be based on faulty assumptions.
Rachel Lampert
For an average of 2.5 years each, the researchers studied athletes with ICDs playing organized (n=328) or high-risk (n=44) sports. During the course of the study, there were 49 shocks in 37 patients (10% of study population) during competition or practice, 39 shocks in 29 participants (8%) during other physical activity, and 33 shocks in 24 people (6%) at rest. There were eight episodes (four during competition/practice, three during other physical activity, and one at rest) of multiple shocks. Although more participants received shocks during physical activity than at rest (16% vs. 6%, P>.0001), there was no difference between those receiving shocks while playing or practicing sports vs. those receiving them during other physical activity (10% vs. 8%; P=.34).
There were no deaths related to athletics, and the rates of shock were similar to non-athletes monitored in previous studies. In each case, the ICD terminated the arrhythmia.
“These data, the only prospective study looking at the safety of sports, do not support the current blanket restriction against sports for patients with ICDs,” Lampert said in an interview.
Instead, the study data indicated that patients with ICDs can play sports without physical injury or untreated arrhythmia, despite the occurrence of appropriate and inappropriate shocks. Therefore, Lampert said, doctors and patients should consider their results when discussing whether playing sports with an ICD is a good idea.
These discussions may help improve patients’ quality of life, according to Lampert. “If, after reviewing the data and clinical situations with their physicians, patients who had previously refrained from sports yet wished to play return, this may increase their quality of life,” she said.
The median age of the participants was 33 years, and 33% were female. Pre-ICD ventricular arrhythmia had been present in 42% of the participants. The primary endpoints were tachyarrhythmic death during or after sports participation, externally resuscitated tachyarrhythmia during or after sports participation, and severe injury from an arrhythmia-related shock during sports. – by Erik Swain
For more information:
Lampert R. Circulation. 2013;127:2021-2030.
Disclosure: The study was sponsored by investigator-initiated grants from Boston Scientific, Medtronic and St. Jude Medical. Lampert reports no relevant financial disclosures.