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Kay B, Lampert R. Devices and Athletics: Decision-Making Around Return to Play. Card Electrophysiol Clin 2024; 16:81-92. [PMID: 38280816 DOI: 10.1016/j.ccep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Until recently, implantable cardioverter defibrillators (ICDs) were considered a contraindication to competitive athletics. Recent prospective observational registry data in athletes with ICDs who participated in sports against the societal recommendations at the time have demonstrated the safety of sports participation. While athletes did receive both appropriate and inappropriate shocks, these were not more frequent during sports participation than other activity, and there were no sports-related deaths or need for external resuscitation in the 440 athlete cohort (median followup 44 months). Optimization of medical therapies, device settings and having an emergency action plan allow many athletes to safely continue athletic activity.
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Affiliation(s)
- Bradley Kay
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA.
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2
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Chorin E, Lampert R, Bijsterveld NR, Knops RE, Wilde AA, Heidbuchel H, Krahn A, Goldenberg I, Rosso R, Viskin D, Frydman S, Lupu L, Viskin S. Safety of Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator (SPORT S-ICD): study rationale and protocol. Heart Rhythm O2 2024; 5:182-188. [PMID: 38560377 PMCID: PMC10980925 DOI: 10.1016/j.hroo.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Recent studies suggest that participation in recreational and even competitive sports is generally safe for patients with implantable cardioverter-defibrillators (ICDs). However, these studies included only patients with implanted transvenous ICD (TV-ICD). Nowadays, subcutaneous ICD (S-ICD) is a safe and effective alternative and is increasingly implanted in younger ICD candidates. Data on the safety of sport participation for patients with implanted S-ICD systems is urgently needed. Objectives The goal of the study is to quantify the risks (or determine the safety) of sports participation for athletes with an S-ICD, which will guide shared decision making for athletes requiring an ICD and/or wishing to return to sports after implantation. Methods The SPORT S-ICD (Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator) study is an international, multicenter, prospective, noninterventional, observational study, designed specifically to collect data on the safety of sports participation among patients with implanted S-ICD systems who regularly engage in sports activities. Results A total of 450 patients will undergo baseline assessment including baseline characteristics, indication for S-ICD implantation, arrhythmic history, S-ICD data and programming, and data regarding sports activities. LATITUDE Home Monitoring information will be regularly transferred to the study coordinator for analysis. Conclusion The results of the study will aid in shaping clinical decision making, and if the tested hypothesis will be proven, it will allow the safe continuation of sports for patients with an implanted S-ICD.
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Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Lampert
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nick R. Bijsterveld
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Reinoud E. Knops
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Arthur A.M. Wilde
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Andrew Krahn
- Division of Cardiology, Center for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ilan Goldenberg
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, Rochester, New York
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Nesti M, Russo V, Palamà Z, Panchetti L, Garibaldi S, Startari U, Mirizzi G, Piacenti M, Rossi A, Sciarra L. The Subcutaneous Implantable Cardioverter-Defibrillator: A Patient Perspective. J Clin Med 2023; 12:6675. [PMID: 37892812 PMCID: PMC10607293 DOI: 10.3390/jcm12206675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a new technology for the management of ICD patients. But what is the patients' perspective? Previous studies on the transvenous ICD (TV-ICD) showed that device implantation is related not only to anxiety and depression because of the fear of ICD shocks, but also to many biopsychosocial factors like body image changes, perceived reduction of socialization and limitation in professional and sports activities. Anxiety and distress are more evident in younger women because of aesthetic reasons. The scar size and the position of the S-ICD can help these patients and positively influence their social relationships. Moreover, the position of the S-ICD reduces possible complications from catheters due to stress injury and can improve patients' professional life by avoiding some work activity limitations. An S-ICD can be also a good option for athletes in avoiding subclavian crash and reducing inappropriate shocks. However, some questions remain unsolved because an S-ICD is not suitable for patients with indications for pacing, cardiac resynchronization therapy or anti-tachycardia pacing. In conclusion, the use of an S-ICD can assist physicians in reducing the negative impact of implantation on the well-being of some groups of patients by helping them to avoid depression and anxiety as well as improving their noncompliance with their medical treatment.
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Affiliation(s)
- Martina Nesti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80126 Naples, Italy;
| | - Zefferino Palamà
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, 74121 Taranto, Italy;
| | - Luca Panchetti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Umberto Startari
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Luigi Sciarra
- Department of Cardiology (UTIC), Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
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Pelliccia A, Day S, Olivotto I. Leisure-time and competitive sport participation: a changing paradigm for HCM patients. Eur J Prev Cardiol 2023; 30:zwad011. [PMID: 36638119 DOI: 10.1093/eurjpc/zwad011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
HCM has long been considered the most frequent cause of death in athletes, and reason for disqualification from sport. However, our perception of the impact of sports on HCM is largely based on anecdotal evidence. In this review, we provide a reappraisal of current knowledge relative to 1) the impact of sport on LV remodeling, and 2) on the clinical outcome of HCM in athletes. 1) The limited available evidence argues against the hypothesis that intensive exercise conditioning may trigger and/or worsen the development of LV hypertrophy or cause changes in LV function in adult HCM athletes. 2) Recent observations challenge the concept of a detrimental effect of sport on HCM clinical course. The Reset-HCM study showed that 16-week moderate-intensity exercise resulted in a small, significant increase in exercise capacity and no adverse events. In a cohort of 88 low-risk HCM athletes followed for a 7-year period, survival analyses showed no difference in mortality between HCM who discontinued or pursued vigorous exercise programmes. Further reassurance was provided by the ICD Sports Safety Registry. Clinical implications: At present, patients' attitude to sport participation is highly variable, based on social and legal backgrounds surrounding medical practice in different countries. The shared-decision-making as suggested by current US and European guidelines allows the physician to deliver a tailored and more liberal advice. Physicians should be aware of the changing paradigm relative to exercise and sport prescription for HCM and promote active lifestyle as an integral component of modern management of HCM patients.
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Affiliation(s)
| | - Sharlene Day
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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5
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 712] [Impact Index Per Article: 356.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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6
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Kay B, Lampert R. Devices and Athletics. Cardiol Clin 2022; 41:81-92. [DOI: 10.1016/j.ccl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Carrington M, Providência R, Chahal CAA, D'Ascenzi F, Cipriani A, Ricci F, Khanji MY. Cardiopulmonary Resuscitation and Defibrillator Use in Sports. Front Cardiovasc Med 2022; 9:819609. [PMID: 35242826 PMCID: PMC8885805 DOI: 10.3389/fcvm.2022.819609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival. This review aims to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.
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Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Rui Providência
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Health Informatics Research, University College London, London, United Kingdom
| | - C. Anwar A. Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Centre for Inherited Cardiovascular Diseases, WellSpan Cardiology, Lancaster, PA, United States
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mohammed Y. Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, United Kingdom
- *Correspondence: Mohammed Y. Khanji
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8
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Abstract
Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.
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Affiliation(s)
- Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. 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; 23:147-148. [PMID: 32596731 DOI: 10.1093/europace/euaa106] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mats Borjesson
- Centre for Health and Performance (CHP), Department of Food, Nutrition and Sport Sciences, Gothenburg University, Sweden.,Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, Rome, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | | | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Domenico Corrado
- Department of Cardiology, University of Padova, Padova, Italy.,Department of Pathology, University of Padova, Padova, Italy
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Boraita A, Adamuz C, Alcocer Ayuga M, Carro A, Díaz González L, Heredia JR, Madaria Z, Masiá MD, Rossi M, Sánchez Testal M, Trias de Bes J, Azcárate P, Barriales R, Benito B, Calvo-Iglesias F, Fuertes Moure Á, de la Guía F, Martínez A, Martínez Alday J, Moñivas V, Peiró Molina E, Vera TR, de la Rosa A, Avanzas P, Congost GB, Boraita A, Bueno H, Calvo D, Campuzano R, Delgado V, Dos L, Ferreira-González I, Gómez Doblas JJ, Pascual Figal D, Sambola Ayala A, Viana Tejedor A, Ferreiro JL, Alfonso F. Comments on the 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:488-493. [PMID: 33773942 DOI: 10.1016/j.rec.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
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Comentarios a la guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 691] [Impact Index Per Article: 230.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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14
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Zorzi A, Cipriani A, Bariani R, Pilichou K, Corrado D, Bauce B. Role of Exercise as a Modulating Factor in Arrhythmogenic Cardiomyopathy. Curr Cardiol Rep 2021; 23:57. [PMID: 33961139 PMCID: PMC8105216 DOI: 10.1007/s11886-021-01489-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The review addresses the role of exercise in triggering ventricular arrhythmias and promoting disease progression in arrhythmogenic cardiomyopathy (AC) patients and gene-mutation carriers, the differential diagnosis between AC and athlete's heart and current recommendations on exercise activity in AC. RECENT FINDINGS AC is an inherited heart muscle disease caused by genetically defective cell-to-cell adhesion structures (mainly desmosomes). The pathophysiological hallmark of the disease is progressive myocyte loss and replacement by fibro-fatty tissue, which creates the substrates for ventricular arrhythmias. Animal and human studies demonstrated that intense exercise, but not moderate physical activity, may increase disease penetrance, worsen the phenotype, and favor life-threatening ventricular arrhythmias. It has been proposed that in some individuals prolonged endurance sports activity may in itself cause AC (so-called exercise-induced AC). The studies agree that intense physical activity should be avoided in patients with AC and healthy gene-mutation carriers. However, low-to-moderate intensity exercise does not appear detrimental and these patients should not be entirely deprived from the many health benefits of physical activity.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Riccardo Bariani
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
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Sciarra L, Salustri E, Petroni R, Calò L, Delise P, Penco M, Romano S. Sport activity in patients with cardiac implantable electronic devices: evidence and perspectives. J Cardiovasc Med (Hagerstown) 2021; 22:335-343. [PMID: 32941324 DOI: 10.2459/jcm.0000000000001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Demographic characteristics of patients with cardiac implantable electronic devices have significantly changed during the last few years, according to the ageing of the population and the consequent increase in the number of elderly individuals with indication for pacemaker implant and, on the other hand, to the increased number of young individuals implanted with an implantable cardioverter defibrillator for the primary prevention of sudden death. More and more often, both elderly and young patients ask the physician to deal with the device in their daily activities, which often include sport practice. This latter is advisable because of its recognized benefits on cardiovascular prevention, although there are many limitations for patients with a cardiac implantable electronic device. Hence, the need to balance the patient's request with the appropriate precautions emerging from existing evidence. The current article aims to provide an overview of the most recent data on this topic, derived from registries and observational studies. Over the years an attempt to standardize recommendations has been made, but robust evidence is still lacking. Substantial differences exist between countries based on their sports regulations. Official recommendations of European and American Scientific Societies are resumed. The future perspective is to obtain data to allow these patients a safer practice of sport activity also through technological advances in terms of device materials and programming improvement and the possibility of remote monitoring.
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Affiliation(s)
- Luigi Sciarra
- Department of Cardiology, Policlinico Casilino, Roma
| | - Elisa Salustri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila
| | - Renata Petroni
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Roma
| | - Pietro Delise
- Division of Cardiology, Hospital 'P. Pederzoli', Peschiera del Garda, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila
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16
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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17
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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18
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Affiliation(s)
- Geza Halasz
- G. da Saliceto Hospital, AUSL Piacenza, Italy
| | - Massimo F Piepoli
- G. da Saliceto Hospital, AUSL Piacenza, Italy.,University of Parma, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Italy
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19
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(Athlete with pacemaker or cardioverter-defibrillator). COR ET VASA 2020. [DOI: 10.33678/cor.2020.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Affiliation(s)
- Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Centre for Cardiac Arrhythmias of Genetic Origin, Italy
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21
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Arrhythmogenic Cardiomyopathy and Sports Activity. J Cardiovasc Transl Res 2020; 13:274-283. [DOI: 10.1007/s12265-020-09995-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/23/2020] [Indexed: 01/01/2023]
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22
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Prior D, La Gerche A. Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy. Heart Lung Circ 2019; 29:547-555. [PMID: 31964580 DOI: 10.1016/j.hlc.2019.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 01/30/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a group of cardiomyopathies associated with ventricular arrhythmias predominantly arising from the right ventricle, sudden cardiac death and right ventricular failure, caused largely due to inherited mutations in proteins of the desmosomal complex. Whilst long recognised as a cause of sudden cardiac death (SCD) during exercise, it has recently been recognised that intense and prolonged exercise can worsen the disease resulting in earlier and more severe phenotypic expression. Changes in cardiac structure and function as a result of exercise training also pose challenges with diagnosis as enlargement of the right ventricle is commonly seen in endurance athletes. Advice regarding restriction of exercise is an important part of patient management, not only of those with established disease, but also in individuals known to carry gene mutations associated with development of ARVC.
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Affiliation(s)
- David Prior
- National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Vic, Australia.
| | - Andre La Gerche
- National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
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23
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Sport Participation in Patients with Implantable Cardioverter-Defibrillators. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:66. [PMID: 31728782 DOI: 10.1007/s11936-019-0772-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf. RECENT FINDINGS The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4 years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes. Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, "may be considered".
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