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Patients with ICDs may engage in sports
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Many patients with implantable cardioverter defibrillators can participate in vigorous sports, according to a research letter in Circulation.
“Our data don’t say that every athlete with a device should just be out there doing every sport, but what they do show is that the decision can be individualized,” Rachel J. Lampert, MD, professor of internal medicine (cardiology) at Yale University School of Medicine, said in an interview with Cardiology Today. “The doctor can take our data, what types of patients were playing, what types of sports were they doing and talk to an individual patient in their office about how do the data apply to them, what can the individual patient take away as far as thinking about the risks and benefits as he or she is thinking about going back to sports.”
Athletes with ICDs
Researchers analyzed data from 440 participants from the ICD Sports Safety Registry who participated in organized sports (n = 393) or high-risk sports (n = 47). Most participants engaged in basketball, running and soccer, with skiing being the most common dangerous sport.
The most common conditions among participants included hypertrophic cardiomyopathy (17%; n = 75), long QT syndrome (20%; n = 87) and arrhythmogenic right ventricular cardiomyopathy (13%; n = 55). Participants were followed up for a median of 44 months.
Injury from shock or arrhythmia-related syncope, tachyarrhythmic deaths or externally resuscitated tachyarrhythmias did not occur during sports.
Ten percent of participants received appropriate shocks during practice or competition (3 per 100 person-years). Shocks occurred more often in participants during physical activity, practice or competition (20%) vs. rest (10%; P < .0001). The rate of shocks during practice or competition (12%) was similar to the rate of shocks during other physical activity (10%; P = .56).
The number of participants who received appropriate shocks during practice, competition or other physical activity was higher (11%) vs. appropriate shocks at rest (6%; P = .005), although shocks during physical activity (5%) and competition/practice (7%) did not differ (P = .08). The rate of appropriate shocks during practice or competition was similar in participants who engaged in highly competitive sports (12%) and those who did not (10%).
Appropriate shocks during practice or competition were more common in those athletes with arrhythmogenic right ventricular cardiomyopathy.
“There are other data from other [studies] out there as well that vigorous exercise is not good for people with this type of problem, and our data further confirms [it],” Lampert told Cardiology Today.
Multiple shocks
A small percentage of participants (4%) received multiple appropriate shocks due to immediate recurrence (n = 6), shock failure (n = 2) or electric storm (n = 8). Most instances of multiple shocks (n = 8) occurred during practice or competition, whereas others occurred during other physical activity (n = 4) and rest (n = 4). Those who received multiple shocks during physical activity had idiopathic ventricular fibrillation, CAD, catecholaminergic polymorphic ventricular tachycardia, sarcoidosis or dilated cardiomyopathy.
The lead malfunction rate for the athletes in the study was similar to that reported in prior studies for the general population of ICD patients.
“There’s a big question that this study raised,” Lampert told Cardiology Today. “There are a number of other heart problems in which people without an ICD are told they should not be participating in sports either, and to what extent those restrictions, which are also based on hypothesized risks, are necessary, I think is an important next study.” – by Darlene Dobkowski
Disclosures: The study was funded by Boston Scientific, Medtronic and St. Jude Medical. Lampert reports receiving consultant fees/honoraria from Medtronic and research grants from Boston Scientific, Medtronic and St. Jude Medical. Please see the study for the other researchers’ relevant financial disclosures.
Perspective
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Richard J. Kovacs, MD
The findings are from an extension of a registry, a study that was originally reported by this group in 2013. They now report experience from 4-year follow-up of a registry for athletes who have implantable defibrillators. The main addition to what we know is a longer period of time that we’ve been able to observe these athletes.
The published guidelines for competitive athletes participating with these kinds of heart diseases have largely precluded them from competitive athletics. Dr. Lampert and her colleagues have started to gather evidence that may change our attitude that it’s an absolute contraindication for these athletes to compete.
This is a registry, and with the inherent issues with registry information, we’d like to see more data from athletes in a trial that is randomized in some way. Data from a randomized trial will be more likely to influence guidelines, but will be difficult to obtain. In the meantime, these observations will serve to influence consensus in the group of cardiologists who care for competitive athletes.
Athletes really need to talk this through with their cardiologist. The data that Dr. Lampert brings forward are coming from centers led by the experts in the field. These athletes did well, at least in part, because they were managed by experts in specialized centers. The athlete who wants to compete with an ICD needs to have a careful conversation with their provider and also consider evaluation in a center that routinely cares for competitive athletes. There are not very many of these places around the country, and there are not very many of these kinds of athletes. It is the kind of care that may best be done in highly specialized centers.
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