Competitive Athletes with Implantable Cardioverter Defibrillators - How to Program? Data from the Implantable Cardioverter Defibrillator Sports Registry
Athletes with ICDs may require unique optimal device-based tachycardia programming.
To assess the association of tachycardia programming characteristics of ICDs with occurrence of shocks, transient loss-of-consciousness, and death among athletes.
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.
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.
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.
Key Words:implantable cardioverter defibrillator, cardiac arrest, ventricular tachycardia, ventricular fibrillation, athletes, sports participation, ICD programming
Autor / Fonte:Brian Olshansky, Gourg Atteya, David Cannom, Hein Heidbuchel, et al. Heart Rhythm: the Official Journal of the Heart Rhythm Society 2018 October 30