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ICDs need not sideline competitive athletes

BOSTON — Participation in competitive sports may be safer than previously thought for patients with implantable cardioverter defibrillators, new data show.

International guidelines recommend that patients with ICDs refrain from moderate- to high-intensity competitive sports. However, few data on actual harms exist, study researcher Rachel Lampert, MD, FRHS, associate professor of medicine at Yale University School of Medicine, said during a presentation at the Heart Rhythm Society’s Annual Scientific Sessions. To close this gap in research, Lampert and colleagues initiated the international ICD Sports Safety Registry. Their study focused on 372 patients with ICDs (mean age, 33 years) at 41 North American and European sites, 134 of whom participated in sports on the interscholastic or state/national levels. The most common sports were running, soccer and basketball.

After a median of 31 months, the researchers found no incidence of death or resuscitated arrest and no incidence of shock- or arrhythmia-related injury during sports participation. Further, only 10% of patients received shocks during competition or practice. Eight ventricular arrhythmias for which multiple shocks were received occurred: seven during competition, practice or other physical activity and one at rest. These episodes occurred in seven patients, including those with CAD, catecholaminergic polymorphic ventricular tachycardia, ventricular fibrillation or hypertrophic cardiomyopathy.

Thirteen definite and 14 probable lead malfunctions were reported. Freedom from definite or possible lead malfunction from time of lead implant was 93% at 5 years and 84% at 10 years, Lampert said at the session.

“This study is the first to collect data on a large number of athletes with ICDs who are actively participating in vigorous competitive sports. Shocks were not rare during sports; however, no serious health consequences occurred,” she said. “Most patients who received shocks while playing returned to sports, implying that the negative impact on quality of life of the shocks was offset for [these patients] by the beneficial effects of quality of life on sports participation.

“These data do not support blanket restriction of athletes with ICDs from participating in sports. Rather, whether patients with ICDs should return to sports should be an individualized decision,” Lampert said. – by Melissa Foster

For more information:

Disclosure: This study was supported by research grants from Boston Scientific, Medtronic and St. Jude Medical. Dr. Lampert has received consulting fees/honoraria from Medtronic, and research grants from Boston Scientific, Medtronic and St. Jude Medical.

BOSTON — Participation in competitive sports may be safer than previously thought for patients with implantable cardioverter defibrillators, new data show.

International guidelines recommend that patients with ICDs refrain from moderate- to high-intensity competitive sports. However, few data on actual harms exist, study researcher Rachel Lampert, MD, FRHS, associate professor of medicine at Yale University School of Medicine, said during a presentation at the Heart Rhythm Society’s Annual Scientific Sessions. To close this gap in research, Lampert and colleagues initiated the international ICD Sports Safety Registry. Their study focused on 372 patients with ICDs (mean age, 33 years) at 41 North American and European sites, 134 of whom participated in sports on the interscholastic or state/national levels. The most common sports were running, soccer and basketball.

After a median of 31 months, the researchers found no incidence of death or resuscitated arrest and no incidence of shock- or arrhythmia-related injury during sports participation. Further, only 10% of patients received shocks during competition or practice. Eight ventricular arrhythmias for which multiple shocks were received occurred: seven during competition, practice or other physical activity and one at rest. These episodes occurred in seven patients, including those with CAD, catecholaminergic polymorphic ventricular tachycardia, ventricular fibrillation or hypertrophic cardiomyopathy.

Thirteen definite and 14 probable lead malfunctions were reported. Freedom from definite or possible lead malfunction from time of lead implant was 93% at 5 years and 84% at 10 years, Lampert said at the session.

“This study is the first to collect data on a large number of athletes with ICDs who are actively participating in vigorous competitive sports. Shocks were not rare during sports; however, no serious health consequences occurred,” she said. “Most patients who received shocks while playing returned to sports, implying that the negative impact on quality of life of the shocks was offset for [these patients] by the beneficial effects of quality of life on sports participation.

“These data do not support blanket restriction of athletes with ICDs from participating in sports. Rather, whether patients with ICDs should return to sports should be an individualized decision,” Lampert said. – by Melissa Foster

For more information:

Disclosure: This study was supported by research grants from Boston Scientific, Medtronic and St. Jude Medical. Dr. Lampert has received consulting fees/honoraria from Medtronic, and research grants from Boston Scientific, Medtronic and St. Jude Medical.

    Perspective
    Peter Kowey

    Peter Kowey

    The ICD Sports Registry is an important study because traditional teaching has been to dissuade people who have ICDs from participating in competitive sports. However, that advice wasn’t based on a lot of information, and it was unduly restrictive. The two primary concerns are the potential for precipitating more arrhythmia and damaging the device. In this study, there weren’t any serious adverse events, though there were a few patients who were shocked. The data don’t support restricting sports activities for patients with ICDs. That’s actually a big relief for a lot of patients who should get an ICD but don’t because they don’t want to give up their participation in sports.

    • Peter Kowey, MD
    • Cardiology Today Editorial Board member

    Disclosures: Dr. Kowey is a consultant to Medtronic and has spoken at symposia sponsored by Boston Scientific and St. Jude Medical.

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