May 21st, 2013
Athletes with ICDs Don’t Need to Quit Sports
Larry Husten, PHD
Although the American College of Cardiology and the European Society of Cardiology now advise people with ICDs not to participate in vigorous sports, a new study offers strong support for people with ICDs who want to take part in sports.
Now findings from the ICD Sports Safety Registry, published in Circulation, provide vital new information about this important topic. The registry, which was performed with the assistance of patient advocacy groups, included 372 ICD patients between 10 and 60 years of age who participated in sports more vigorous than golf or bowling. The most common reasons for having an ICD among people in the registry were long-QT syndrome in 73 people, hypertrophic cardiomyopathy in 63, and arrhythmogenic right ventricular cardiomyopathy in 55. Of the subjects, 60 were college age or younger who took part in competitive sports.
The main finding of the study was reassuring: not one participant died, needed to be resuscitated, or suffered a severe arrhythmia-related injury while playing sports during the average of two and one-half years that patients were followed in the study. In addition:
- 77 people had 121 shocks during the course of the study,
- 40 people had at least 1 inappropriate shock,
- 36 people had shocks during competition or practice,
- 29 people had shocks during other physical activity, and
- 23 people had shocks during rest.
The study authors discussed the complex effect of ICDs on quality-of-life in this group:
Healthy college athletes have higher physical, emotional, and social functioning and quality-of-life scores than nonathletes, yet athletes sidelined with an injury score lower in all of these domains than both active athletes and nonathletes. Many adolescents with ICDs and their physicians report restriction from sports and the resultant feeling of not being normal as one of the most important negative aspects of their device.”
Limiting sports participation might also have a paradoxical impact on survival. The authors observed that although exercise can trigger lethal arrhythmias in the short term, “the better conditioned the individual, the less likely overall he or she is to die suddenly.” But it is not known whether this holds true for younger people with arrhythmogenic conditions.
The authors concluded that “a blanket recommendation against competitive sports for all patients with ICDs is not warranted. There are risks and benefits of sports participation. However, neither do these data suggest that all sports are safe for all patients.”
The registry was funded by the ICD manufacturers Boston Scientific, Medtronic, and St. Jude Medical.
2 Responses to “Athletes with ICDs Don’t Need to Quit Sports”
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Electrophysiologist Westby Fisher sent the following comment:
This prospective study by Lampert and colleagues studied the incidence of ICD shocks and ICD mechanical failures in patients who participated in a wide variety of sports activities far greater than those previously recommended by 2006 ICD guidelines. From tackle football, basketball, soccer, baseball, hockey, skiing, snowboarding, tennis, and even wrestling – patients with ICDs had no occurrences of tachyarrhythmic death or externally resuscitated tachyarrhythmia during or after sports participation. This is not to say no patients were treated by their device: 77 patients received 121 shock episodes with 13% receiving appropriate shocks and 11% receiving at least one inappropriate shock. What was interesting was that only 10% of those patients receiving shocks did so during competition or sports participation. There was no difference in the proportion of patients receiving a shock during practice or competition and those receiving a shock during other physical activity. Additionally, there were no moderate injuries related to arrhythmias or shocks received during sports.
For patients with ICDs that want to participate in competitive sports, this study should lend reassurance to the safety of ICDs in this setting. It should be noted, however, that the 10-year lead survival rate (90%) was similar to 10-year ICD lead survival rates seen in children (http://content.onlinejacc.org/article.aspx?articleid=1664430). ICD lead survival rates in adults at 10 years have approached 95-98%, suggesting that active sports participation may increase the need for ICD system revisions at a slightly higher rate than that seen in adults – a point important to mention to ICD patients who might be considering sports participation.
Finally, the article does not mention the time patients waited after ICD implantation to participate actively in sports. It is critical that patients allow sufficient time for their lead systems to completely adhere to their heart. This should be discussed with the implanting physician and may vary depending on the type of sport to be pursued.
Authors are to be complimented for this study. Increased awareness of sudden cardiac death and increased screening both phenotypic and genotypic, has led to an increase in number of ICD implants in young or middle aged adults. Since our risk stratification parameters are only modestly specific at best, we may be implanting some lower risk patients and unnecessarily limiting their activities.
I think fear and/or prudence has guided the expert opinion behind restriction of physical activity in these patients. The current study shows no significant “observed” ill effects that could be directly attributed to competitive sports participation in patients with ICD.
Is it the time for lifting activity restrictions ?
Since this was is a self selected group of patients in a registry, some health skepticism is warranted. However this is not a issue, which could be a subject of randomized trial; Our hope for best evidence is longer follow up from registries of this type.
For now, I think its a good news for patients who want to engage in significant physical activity with ICD in situ