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Athletes with implantable cardioverter-defibrillators (ICDs) may be able to safely compete, although there may be appropriate and inappropriate shocks, according to longer-term follow-up of the registry that changed the ICD guidelines to allow sports.

None of the 440 participants died from or were externally resuscitated for tachyarrhythmia during or after sports participation in the median 44 months of follow-up. from arrhythmia-related syncope or shock during sports, Rachel Lampert, MD, of Yale University in New Haven, Conn., and colleagues reported in a research letter in Circulation.

The 95% confidence interval for the occurrence of adverse event in the complete 4 years of follow-up was 0% to 2.2%.

The multinational, prospective ICD Sports Safety Registry included 393 athletes in organized sports (most commonly running, basketball, or soccer) and 47 in high-risk sports (typically skiing). Their most common diagnoses were long-QT syndrome (20%), hypertrophic cardiomyopathy (17%), and arrhythmogenic right ventricular cardiomyopathy (13%).

Ventricular fibrillation or tachycardia occurred during sports in 30% of the 201 individuals with a pre-ICD history of these events. Appropriate ICD shocks for such events occurred in 10% of participants during competition or practice, for a rate of 3 per 100 person-years. These shocks were more likely during physical activity than rest (20% versus 10%; P<0.0001) but not more likely during competition or practice than during other physical activity (12% versus 10%; P=0.56).

Highly competitive sports didn't differ from other sports, although arrhythmogenic right ventricular cardiomyopathy was a risk factor and linked to multiple shocks.

"Underlying disease should be considered, in particular arrhythmogenic right ventricular cardiomyopathy, because exercise increases disease progression and arrhythmia," the researchers concluded. "These data can guide more informed individualized physician and patient decision making for sports participation for athletes with ICDs and continue to support the recent change in eligibility recommendations."

Consensus documents formerly advised against sports more vigorous than golf for ICD recipients. After the registry's initial results showed no real risk of death, failure to defibrillate, or injury from arrhythmia or shock during sports in these patients, the 2015 American Heart Association/American College of Cardiology recommendations for competitive athletes shifted to state that competitive sports may be considered for those with ICDs.

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