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Written by: Jody Murray, Bsc/BPhe, MD, CCFP and current Sport Medicine Fellow
Article: Athletes with implantable cardioverter defibrillators: can they return to competitive sports? Prutkin JM, et al. Br J Sports Med January 2016 Vol 50 No 2.
As a sport medicine physician, sudden cardiac death is at the top of the list of worst case scenarios for event coverage. Sudden Cardiac Death (SCD) represents 75% of fatalities during exertion and is most commonly due to an undiagnosed either electrical or structural cardiovascular condition.
Pre-participation screening involves taking a thorough history of cardiac symptoms and family history in order to identify an athlete at risk. On history one should ask about chest pain, dyspnea, palpitations, dizziness or syncope during exertion. Upon family history one should ask about any deaths that occurred to relatives that were at a young age and unexplained. This may also include unexplained drowning in individuals that were strong swimmers.
If you have identified an athlete at risk for SCD, they should undergo further cardiovascular investigations including an ECG, echo and be referred for evaluation by a specialist.
The most common conditions identified include premature coronary artery disease, cardiomyopathies (such as hypertrophic cardiomyopathy), congential coronary anomalies, congenital valvular heart disease and ion channelopathies (such as brugada syndome). Some of these conditions are managed by inserting implantable cardioverter defibrillators (ICD).
The above article recently published by the BJSM looked at what do with these athletes following ICD insertion. Can they return to competitive sports? Previous recommendations from the American College of Cardiology and the European Society of Cardiology stated they could return to low-intensity sports only. These guidelines were based on expert opinion with limited data.
Recent data looking at ICD failures and the number of shocks delivered (either appropriate and inappropriate) has led to the new conclusion that athletes with ICDs can play sports safely. The 2015 American College of Cardiology and American Heart Association guidelines state now that sports partification with an ICD may be allowed if there have been no shocks for 3 months. A discussion should be had with the family and the athlete about the risks involved in returning to competitive sport such that the athlete and their family can make an informed decision about future participation.