Safety of Sports for Patients With ICDs: Results of a Prospective Multinational Registry

Lampert, Rachel; Olshansky, Brian; Heidbüchel, Hein; Lawless, Christine E.; Saarel, Elizabeth V.; Ackerman, Michael H.; Calkins, Hugh; Estes, Mark; Link, Mark; Maron, Barry J.; Marcus, Frank I.; Scheinman, Melvin M.; Wilkoff, Bruce L.; Zipes, Douglas P.; Berul, Charles I.; Cheng, Alan G.; Law, Ian H.; Loomis, Michelle; Barth, Cheryl; Brandt, Cynthia; Dziura, James; Li, Fangyong; Cannom, David S.

doi:10.1016/j.hrthm.2012.06.014

Cited by 7 publications

(11 citation statements)

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“…(21) Fewer data are available regarding the safety of exercise in patients with HF and ICDs. Single-center experiences in small cohorts of ICD patients have demonstrated the feasibility of cardiopulmonary rehabilitation programs without evidence of major safety concerns.…”

Section: Discussionmentioning

confidence: 99%

Exercise Training and Implantable Cardioverter-Defibrillator Shocks in Patients With Heart Failure

Piccini

Hellkamp

Whellan

et al. 2013

JACC: Heart Failure

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Objectives To determine if exercise training is associated with an increased risk of implantable cardioverter defibrillator (ICD) therapies in patients with heart failure (HF). Background Few data are available regarding the safety of exercise training in patients with ICDs and HF. Methods Heart Failure: A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) randomized 2331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relation between exercise training and ICD shocks. Results We identified 1053 patients (45%) with an ICD at baseline randomized to exercise training (n=546) or usual care (n=507). The median age was 61 and the median EF was 24%. Over a median 2.2 years of follow-up, 20% (108) of the exercise patients had a shock versus 22% (113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (HR 1.93 [1.47-2.54]), prior atrial fibrillation/flutter (HR 1.63 [1.22-2.18]), exercise induced dysrhythmia (HR 1.67 [1.23-2.26]), lower diastolic blood pressure (HR for 5 mmHg decrease < 60: 1.35 [1.12-1.61]), and non-white race (HR 1.50 [1.13-2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR 0.90 [0.69-1.18], p=0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR 0.99 [0.86-1.14], p=0.90). Conclusions We found no evidence of increased ICD shocks in patients with HF and reduced LV function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF.

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Section: Discussionmentioning

confidence: 99%

Exercise Training and Implantable Cardioverter-Defibrillator Shocks in Patients With Heart Failure

Piccini

Hellkamp

Whellan

et al. 2013

JACC: Heart Failure

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“…Lampert et al (18) study has some very important limitations. The patients were self referred and they may or may not represent the ICD recipient athletic population.…”

Section: Everyday Clinical Practice and Challenging Evidencementioning

confidence: 92%

“…In the 2006 retrospective survey of members of the Heart Rhythm Society, more than 40% of participants reported at least one ICD recipient participating in competitive or high intensity recreational sport (17). This survey provided justification for a prospective international registry to identify and quantify the risks of competitive or high intensity sport in ICD recipients (18). A landmark study published by Lampert et al enrolled 372 ICD recipients.…”

Section: Everyday Clinical Practice and Challenging Evidencementioning

confidence: 99%

“…Though in MADIT there are limitations of rather different patient population with over 50% patients with ischaemic cardiomyopathy and a shorter follow up period of 16.8 months. Focusing on the shocks in Lampert et al trial, 48 participants (13% of population) received at least 1 appropriate shock and 40 (11%) received at least one inappropriate shock (18).…”

Section: Everyday Clinical Practice and Challenging Evidencementioning

confidence: 99%

“…Lampert et al (18) in their trial also identified a subgroup of patients requiring multiple shocks focusing on the 7 patients (2% of population) with 8 arrhythmia episodes requiring more than one high energy ICD discharge. 4 episodes were during competition/ practice, 3 during other physical activity and 1 during rest.…”

Section: Everyday Clinical Practice and Challenging Evidencementioning

confidence: 99%

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Changing Views: Safety and Efficacy of Implantable Cardioverter-Defibrillator Therapy in Athletes

Pavlů¹,

Hutyra²,

Táborský³

2015

Cent Eur J Public Health

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The implantable cardioverter-defibrillator (ICD) is highly effective in reducing sudden death from ventricular tachyarrhythmia among high-risk cardiac patients. Conventional advice given to patients with ICD is to avoid physical activity more strenuous than playing golf or bowling. This recommendation is given due to a theoretical risk of arrhythmia precipitation, and thus increased risk of death due to failure to defibrillate, injury resulting from loss of control caused by arrhythmia-related syncope or shock, and also due to sport related direct damage to the ICD system. Recent prospective data from an international registry involving 372 athletes with ICDs in situ and actively participating in sports has been published. This indicates that, although physical activity resulted in an increased number of shocks compared to rest, there was no significant difference between intensive physical activity and any other activity (10% vs. 8%, p=0.34) in frequency of shocks. Furthermore, over a median follow-up period of 31 months (21-46 months), in the period of sports activity and 2 hour rest directly after there were no occurrences of death, resuscitated arrest or arrhythmia, or shock-related injury. This data is likely to start a shift in every-day clinical decision-making leading to revision of the high level of precautions imposed on the rapidly enlarging ICD recipient population.

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Implantable Cardioverter-Defibrillator Therapy in Athletes

ElMaghawry

Migliore

Zorzi

et al. 2013

Cardiac Electrophysiology Clinics

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Safety of Sports for Patients With ICDs: Results of a Prospective Multinational Registry

Cited by 7 publications

References 0 publications

Exercise Training and Implantable Cardioverter-Defibrillator Shocks in Patients With Heart Failure

Exercise Training and Implantable Cardioverter-Defibrillator Shocks in Patients With Heart Failure

Changing Views: Safety and Efficacy of Implantable Cardioverter-Defibrillator Therapy in Athletes

Implantable Cardioverter-Defibrillator Therapy in Athletes

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