Athletes and Implantable Cardioverter-defibrillators
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Abstract
Athletes with implantable cardioverter-defibrillators (ICDs) have variable underlying diseases and indications for device implantation. Both appropriate and inappropriate shocks were found in the large ICD Sports Registry, but there was no difference of the numbers of shocks between during sports activities or other activities. Additionally, there was no report of sport-related sudden cardiac death or need for cardiopulmonary resuscitation. In the past, athletes with ICDs were restricted from sports participation. Recent guidelines emphasize a shared decision-making approach with athletes and their loved ones. Device programming for higher cut-off rate and longer detection times can reduce all shocks without increasing the incidence of adverse reactions. However, optimization of medications and emergency action plans is needed for all athletes, coaches, and teammates in the event of an emergency.
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References
Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 2011;123(15): 94-600.
Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42(11):1959-63.
Graham R, McCoy MA, Schultz AM, editors. Strategies to improve cardiac arrest survival: a time to act. Washington (DC): National Academies Press (US); 2015.
Ackerman MJ, Zipes DP, Kovacs RJ, Maron BJ, American Heart Association E, Arrhythmias Committee of Council on Clinical Cardiology CoCDiYCoC, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 10: The cardiac channelopathies: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015;132(22):e326-9.
McAllister DR, Motamedi AR, Hame SL, Shapiro MS, Dorey FJ. Quality of life assessment in elite collegiate athletes. Am J Sports Med 2001;29(6):806-10.
Rahman B, Macciocca I, Sahhar M, Kamberi S, Connell V, Duncan RE. Adolescents with implantable cardioverter defibrillators: a patient and parent perspective. Pacing Clin Electrophysiol 2012;35(1):62-72.
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43(40):3997-4126.
Lampert R, Cannom D, Olshansky B. Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of heart rhythm society members. J Cardiovasc Electrophysiol 2006;17(1):11-5.
Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry. Circulation 2013;127(20):2021-30.
Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: long-term results of a prospective multinational registry. Circulation 2017;135(23):2310-2.
Providencia R, Kramer DB, Pimenta D, Babu GG, Hatfield LA, Ioannou A, et al. Transvenous implantable cardioverter-defibrillator (ICD) lead performance: a meta-analysis of observational studies. J Am Heart Assoc 2015;4(11):e002418.
Link MS, Sullivan RM, Olshansky B, Cannom D, Berul CI, Hauser RG, et al. Implantable cardioverter defibrillator lead survival in athletic patients. Circ Arrhythm Electrophysiol 2021;14(3):e009344.
Heidbuchel H, Willems R, Jordaens L, Olshansky B, Carre F, Lozano IF, et al. Intensive recreational athletes in the prospective multinational ICD sports safety registry: results from the European cohort. Eur J Prev Cardiol 2019;26(7):764-75.
Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000;343(19):1355-61.
James CA, Bhonsale A, Tichnell C, Murray B, Russell SD, Tandri H, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/ cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol 2013;62(14):1290-7.
Ruwald AC, Marcus F, Estes NA, Link M, McNitt S, Polonsky B, et al. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2015;36(27):1735-43.
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, et al. 2020 AHA/ACC Guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. circulation 2020;142(25):e558-631.
Konhilas JP, Watson PA, Maass A, Boucek DM, Horn T, Stauffer BL, et al. Exercise can prevent and reverse the severity of hypertrophic cardiomyopathy. Circ Res 2006;98(4):540-8.
Johnson JN, Ackerman MJ. Return to play? Athletes with congenital long QT syndrome. Br J Sports Med 2013;47:28-33.
Ostby SA, Bos JM, Owen HJ, Wackel PL, Cannon BC, Ackerman MJ. Competitive sports participation in patients with catecholaminergic polymorphic ventricular tachycardia: a single center's early experience. JACC Clin Electrophysiol 2016;2(3):253-62.
Manotheepan R, Saberniak J, Danielsen TK, Edvardsen T, Sjaastad I, Haugaa KH, et al. Effects of individualized exercise training in patients with catecholaminergic polymorphic ventricular tachycardia type 1. Am J Cardiol 2014;113(11):1829-33.
Kim JH, Malhotra R, Chiampas G, d'Hemecourt P, Troyanos C, Cianca J, et al. Cardiac arrest during long-distance running races. N Engl J Med 2012;366(2):130-40.
Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, et al. Sports cardiology: core curriculum for providing cardiovascular care to competitive athletes and highly active people. J Am Coll Cardiol 2017;70(15):1902-18.
Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Lindhardt TB, Nielsen JC, et al. Temporal incidence of appropriate and inappropriate therapy and mortality in secondary prevention ICD patients by cardiac diagnosis. JACC Clin Electrophysiol 2021;7(6):781-92.
Wilkoff BL, Hess M, Young J, Abraham WT. Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac resynchronization therapy patients. J Cardiovasc Electrophysiol 2004;15(9):1002-9.
Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, et al. Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000;101(11):1297-302.
Antiarrhythmics versus Implantable Defibrillators (AVI) Investigator. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997;337(22):1576-83.
Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA, 3rd, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015;132(22):e273-80.
Maron BJ, Zipes DP, Kovacs RJ, American Heart Association E, Arrhythmias Committee of Council on Clinical Cardiology CoCDiYCoC, Stroke Nursing CoFG, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles, and general considerations: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015;132(22):e256-61.
Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NAM. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015;66(21):2412-23.
Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S, et al. 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021;42(1):17-96.
Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, et al. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. Europace 2021;23(1):147-8.
Lampert R, Zipes DP. Updated recommendations for athletes with heart disease. Annu Rev Med 2018;69:177-89.
Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017;4(4):CD001431.
Nash D, Lee HR, Janson C, Richardson-Olivier C, Shah MJ. Video game ventricular tachycardia: The "Fortnite" phenomenon. HeartRhythm Case Rep 2020;6(6):313-7.
Kurtzwald-Josefson E, Hochhauser E, Katz G, Porat E, Seidman JG, Seidman CE, et al. Exercise training improves cardiac function and attenuates arrhythmia in CPVT mice. J Appl Physiol (1985) 2012;113(11):1677-83.
Alkharaza A, Al-Harbi M, El-Sokkari I, Doucette S, MacIntyre C, Gray C, et al. The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy. BMC Cardiovasc Disord 2020;20(1):455.
De Ferrari GM, Dusi V, Spazzolini C, Bos JM, Abrams DJ, Berul CI, et al. Clinical management of catecholaminergic polymorphic ventricular tachycardia: the role of left cardiac sympathetic denervation. Circulation 2015;131(25):2185-93.
Kutyifa V, Daubert JP, Schuger C, Goldenberg I, Klein H, Aktas MK, et al. Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: a MADIT-RIT sub-study. Circ Arrhythm Electrophysiol 2016;9(1):e001965.
Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012;367(24):2275-83.
Olshansky B, Atteya G, Cannom D, Heidbuchel H, Saarel EV, Anfinsen OG, et al. Competitive athletes with implantable cardioverter-defibrillators-How to program? Data from the implantable cardioverter-defibrillator sports registry. Heart Rhythm 2019;16(4):581-7.
Slotwiner D, Varma N, Akar JG, Annas G, Beardsall M, Fogel RI, et al. HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015;12(7):e69-100.
Knops RE, Olde Nordkamp LRA, Delnoy PHM, Boersma LVA, Kuschyk J, El-Chami MF, et al. Subcutaneous or transvenous defibrillator therapy. N Engl J Med 2020;383(6):526-36.
Schneider AE, Burkhart HM, Ackerman MJ, Dearani JA, Wackel P, Cannon BC. Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: an effective alternative to the transvenous approach. Heart Rhythm 2016;13(9):1905-12.
Shapero K, Gier C, Briske K, Spatz ES, Wasfy M, Baggish AL, et al. Experiences of athletes with arrhythmogenic cardiac conditions in returning to play. Heart Rhythm O2 2022;3(2):133-40.
Parsons JT, Anderson SA, Casa DJ, Hainline B. Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 Medical and Sports Medicine Organisations. J Athl Train 2019;54(8):843-51.