Sports with ICD or Pacemaker

The number of patients with implanted cardioverter defibrillator (ICD) and pacemaker is constantly increasing. For this reason, cardiologists working in sports medicine are increasingly confronted with the question of the fitness of athletes or active people with ICDs or pacemakers for sports. Previous recommendations disqualified athletes with ICDs for almost any competitive sport. A change in perspective, which was ultimately reflected in the updated American and European guidelines, was caused by the data of the "ICD Sports Safety" Register, which systematically records the risks that may arise during sports participation of athletes with guideline-compliant ICD implantation. During the observation period, no tachyarrhythmia induced deaths or externally terminated tachyarrhythmias during or after the exercise of the sport or injuries due to arrhythmogenic syncope or shock delivery occurred. According to the current guidelines, whether an athlete with an ICD can participate in competitive sports is a decision to be made on a case-by-case basis. Under certain conditions participation in competitive sport appears possible, whereby the pros and cons must be carefully weighed and, especially in professional sport, legal aspects must also be taken into account. According to the current study situation, health sports for ICD wearers are considered safe. Comparable to competitive sports, the evaluation of fitness for sports is mainly based on the cardiovascular basic disease as an important determinant, but ICD-specific considerations should also be considered in the individual decision. In pacemaker wearers, cardiopulmonary performance is initially impaired by the primarily electrical, bradycardic disease of the heart and the resulting chronotropic incompetence, which usually results when left untreated, and can be remedied by the pacemaker. The pacemaker unit and its adjustment is therefore an important - and often decisive - determinant of cardiopulmonary performance in patients with purely electrical disease. The European recommendations for sports suitability, which have not yet been updated, are still relatively restrictive, whereas the new American guidelines are far more moderate: As a rule, sports fitness can be granted if there are no limitations regarding the underlying cardiac disease or symptoms, although some pacemaker-specific aspects must be considered.