Competitive Athletes with Implantable Cardioverter Defibrillators - How to Program? Data from the Implantable Cardioverter Defibrillator Sports Registry.

Olshansky, Brian; Atteya, Gourg; Cannom, David; Heidbuchel, Hein; Saarel, Elizabeth; Anfinsen, Ole-Gunnar; Cheng, Alan; Gold, Michael R; Müssigbrodt, Andreas; Patton, Kristen K; Saxon, Leslie; Wilkoff, Bruce; Willems, Rik; Dziura, James; Li, Fangyong; Brandt, Cynthia; Simone, Laura; Wilhelm, Matthias; Lampert, Rachel (2019). Competitive Athletes with Implantable Cardioverter Defibrillators - How to Program? Data from the Implantable Cardioverter Defibrillator Sports Registry. Heart rhythm, 16(4), pp. 581-587. Elsevier 10.1016/j.hrthm.2018.10.032

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BACKGROUND

Athletes with ICDs may require unique optimal device-based tachycardia programming.

OBJECTIVE

To assess the association of tachycardia programming characteristics of ICDs with occurrence of shocks, transient loss-of-consciousness, and death among athletes.

METHODS

A sub-analysis of a prospective, observational, international registry of 440 athletes with ICDs followed 44 months (median) was performed. Programming characteristics were divided into groups for rate cut-off, very high, high, and low and for detection, long-detection intervals (>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 from 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, of which, 64 were appropriate, 32 were inappropriate; 2 patients received both. Programming a high-rate cutoff was associated with decreased risk of total (P=0.01) and inappropriate (P=0.04) 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 cut-off and long detection duration programming of ICDs in athletes at risk of sudden death can reduce total and inappropriate ICD shocks without affecting survival or the incidence of transient loss-of-consciousness.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Wilhelm, Matthias
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1547-5271
Publisher:	Elsevier
Language:	English
Submitter:	Michelle Dysli
Date Deposited:	08 Feb 2019 14:48
Last Modified:	05 Dec 2022 15:21
Publisher DOI:	10.1016/j.hrthm.2018.10.032
PubMed ID:	30389442
Uncontrolled Keywords:	ICD programming athletes cardiac arrest implantable cardioverter defibrillator sports participation ventricular fibrillation ventricular tachycardia
URI:	https://boris.unibe.ch/id/eprint/121849