Exercise and Competitive Sports in Patients With an Implantable Cardioverter-defibrillator

Hein Heidbuchel; Francois Carré


Eur Heart J. 2014;35(44):3097-3102. 

In This Article

Abstract and Introduction


Implantable cardioverter-defibrillators (ICDs) prevent sudden arrhythmic death in patients with different arrhythmogenic cardiac diseases. Because intense physical activity may trigger ventricular arrhythmias and may favour inappropriate shock delivery that impacts quality of life, current international recommendations only give clearance for moderate leisure-time physical activity to patients with an ICD. Hence, athletes are deemed non-eligible to compete with their ICD. The rationale for the current restriction from competitive sports is discussed in this review, as well as new insights that may alter these recommendations for certain sports participants in the foreseeable future. This review provides guidance for the choice of a durable lead and device system, careful programming tailored to the characteristics of the patient's physiological and pathological heart rhythms, instalment of preventive bradycardic medication, and guided rehabilitation with psychological counselling, allowing a maximum of benefit and a minimum of harm for physically active ICD patients.


Sudden cardiac death (SCD) accounts for up to 50% of all cardiovascular mortality worldwide, and is mainly due to malignant ventricular arrhythmias. The implantable cardioverter-defibrillator (ICD) is a proven effective therapy to prevent SCD in high-risk cardiac patients and is considered standard therapy for primary and secondary prophylaxis of SCD in many indications.[1] Such patients may be athletic and/or physically active people. This review discusses some specific considerations about ICD therapy in such a population.

This paper was an invited review, requested by the Editor of the European Heart Journal after a pro-contra debate between the authors during the ESC Meeting 2013 (Amsterdam). This text refers to the existing recommendations, both European and American, and puts those into context with new information. Both authors are members of the ESC/EACPR Section on Sports Cardiology (and H.H. was Chair of that Section from 2010 to 2012) that issued the European recommendations. Moreover, H.H. was the first author of the Section's Recommendations on ICDs in athletes, and he was the European coordinator of the US/EU ICD Registry in Athletes. That Registry was endorsed by both the Section on Sports Cardiology of EACPR and by the Scientific Committee of EHRA.