Competitive athletes with implantable cardioverter–defibrillators—How to program? Data from the Implantable Cardioverter–Defibrillator Sports Registry

Brian Olshansky, Gourg Atteya, David Cannom, Hein Heidbuchel, Elizabeth V. Saarel, Ole Gunnar Anfinsen, Alan Cheng, Michael R. Gold, Andreas Müssigbrodt, Kristen K. Patton, Leslie A. Saxon, Bruce L. Wilkoff, Rik Willems, James Dziura, Fangyong Li, Cynthia Brandt, Laura Simone, Matthias Wilhelm, Rachel Lampert

Research output: Contribution to journalArticle

Abstract

Background: Athletes with an implantable cardioverter–defibrillator (ICD) may require unique optimal device-based tachycardia programming. Objective: The purpose of this study was to assess the association of tachycardia programming characteristics of ICDs with occurrence of shocks, transient loss-of-consciousness, and death among athletes. Methods: A subanalysis of a prospective, observational, international registry of 440 athletes with ICDs followed for a median of 44 months was performed. Programming characteristics were divided into groups for rate cutoff (very high, high, or low) and detection (long-detection interval [>nominal] or nominal). Endpoints included total, appropriate, and inappropriate shocks, transient loss-of-consciousness, and mortality. Results: In this cohort, 62% were programmed with high-rate cutoff and 30% with long detection. No athlete died of an arrhythmia (related or unrelated) to ICD shocks. Three patients had sustained ventricular tachycardia below programmed detection rate, presenting as palpations and/or dizziness. ICD shocks were received by 98 athletes (64 appropriate, 32 inappropriate); 2 patients received both. Programming a high-rate cutoff was associated with decreased risk of total (P =.01) and inappropriate (P =.04) shocks overall and during competition or practice. Programming long-detection intervals was associated with fewer total shocks. Single- vs dual-chamber devices and the number of zones were unrelated to risk of shock. Transient loss-of-consciousness, associated with 27 appropriate shocks, was not related to programming characteristics. Conclusion: High-rate cutoff and long-detection duration programming of ICDs in athletes at risk for sudden death can reduce total and inappropriate ICD shocks without affecting survival or the incidence of transient loss-of-consciousness.

Original languageEnglish (US)
Pages (from-to)581-587
Number of pages7
JournalHeart Rhythm
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2019

Keywords

  • Athletes
  • Cardiac arrest
  • Implantable cardioverter–defibrillator
  • Implantable cardioverter–defibrillator programming
  • Sports participation
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Olshansky, B., Atteya, G., Cannom, D., Heidbuchel, H., Saarel, E. V., Anfinsen, O. G., Cheng, A., Gold, M. R., Müssigbrodt, A., Patton, K. K., Saxon, L. A., Wilkoff, B. L., Willems, R., Dziura, J., Li, F., Brandt, C., Simone, L., Wilhelm, M., & Lampert, R. (2019). Competitive athletes with implantable cardioverter–defibrillators—How to program? Data from the Implantable Cardioverter–Defibrillator Sports Registry. Heart Rhythm, 16(4), 581-587. https://doi.org/10.1016/j.hrthm.2018.10.032