IJCS | Volume 32, Nº4, July/August 2019

DOI: 10.5935/2359-4802.20190059 Rachel Lampert Professor of Medicine (Cardiology/ Electrophysiology) Yale School of Medicine rachel.lampert@yale.edu 391 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2019;32(4):391-395 Mailing Address: Rachel Lampert Yale School of Medicine - 789 Howard Avenue. Postal Code: 06520-8055, New Haven, Connecticut - USA E-mail: rachel.lampert@yale.edu Update on Sports Participation for Athletes with Implantable Cardioverter Defibrillators Rachel Lamper t Yale School of Medicine, New Haven, Connecticut - USA Manuscript received April 17, 2019; revised manuscript April 27, 2019; accepted May 04, 2019. Athlete; Implantable Cardioverter Defibrillator. Keywords Abstract Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, for ventricular and supraventricular arrhythmias. While more athletes received shocks during physical activity than at rest, there were no differences between competition or practice, versus other physical activity. Programming with higher rate cut-offs and longer durations was associated with fewer inappropriate shocks, with no increase in syncope. Based on this study, current recommendations now state that returning to competition may be considered for an athlete with an ICD. In considering this decision, the underlying disease and type of sport should be discussed, and shared decision-making between doctor, patient, and often family, is critical. Introduction The number of athletes diagnosedwith cardiovascular disease placing them at risk for sudden death, whether through presentation with symptoms such as syncope or cardiac arrest, or through screening efforts, will likely continue to increase. In Europe, ECG screening of athletes is recommended by professional societies 1 and while consensus statements in the US continue to support pre-participation evaluation (PPE) with just history and physical examination, 2 these too may diagnose life- threatening cardiac conditions, and many universities in the US have added ECG to the PPE. 3 Furthermore, family cascade screening increases the rate of diagnosis of asymptomatic family members after presentation of a symptomatic proband. 4,5 Many of these symptomatic and asymptomatic athletes will receive defibrillators, raising the question of the safety of returning to practice. Historical perspective Until recently, consensus statements from the American College of Cardiology and European Society for Cardiology 6-8 advised that patients with ICDs should not participate in sports more vigorous than the “IA” class, low-dynamic/low-static activities such as bowling or golf. The basis for these recommendations were postulated risks, based on the consensus of experts, of failure to defibrillate, injury caused by loss of control due to arrhythmia-related syncope and/or shock, or damage to the ICD system. However, restriction from sports also has downsides, as the psychological as well as physiological benefits of exercise and sports are well-