AICDTherapy in Athletes

16 Pages·2020·1.54 MB·English

Implantable Cardioverter Defibrillator
Therapy in Athletes

Hein Heidbu¨ chel, MD, PhD

Cardiology–Electrophysiology, University Hospital Gasthuisberg, University of Leuven,
Herestraat 49, B-3000 Leuven, Belgium, Europe

Over the last decade implantable cardioverter
defibrillators (ICD) have become accepted ther-
apy in patients with ventricular arrhythmias. They
can be used for secondary prophylaxis, such as
after a prior cardiac arrest caused by ventricular
fibrillation (VF), or in patients who have de-
veloped a sustained ventricular tachycardia (VT)
with hemodynamic compromise. They are also
used progressively more often for primary pro-
phylactic indications, as in patients with left
ventricular systolic dysfunction or inherited car-
diomyopathies with increased risk for sudden
death. Also, in athletic and physically active
young people, ICDs can be applied for secondary
or primary prophylaxis. Their use in this patient
group, however, implies some specific consider-
ations, which form the subject of this article.

Indications for ICD therapy in athletes

The indications for ICD therapy in general
have been extensively reviewed in recently up-
dated American College of Cardiology/American
Heart Association Task Force and the European
Society of Cardiology guidelines on the manage-
ment of patients with ventricular arrhythmia [1].
Their use in athletes has also been outlined in
North American and European guidelines [2–4].

More recent recommendations have described
ICD indications in patients performing leisure
time physical activity [5].
In most athletes treated with an ICD, un-
derlying structural heart disease or an inherited
channelopathy (like the long QT syndrome) is
present. However, this underlying etiology may
not have been overt before. Intensive exertion
may trigger ventricular arrhythmias at a time
when no other symptoms of the underlying
pathology are obvious. Therefore, documented
ventricular arrhythmias during regular follow-up
of athletes, or revealed after more thorough
cardiovascular evaluation for aspecific symptoms
(such as exertional dizziness, shortness of breath,
or syncope), should prompt a careful assessment.
Long-term ECG recordings (by Holter or event
recorder) may show frequent ventricular ectopy or
nonsustained ventricular tachycardia. Imaging
techniques such as echocardiography, cardiac
magnetic resonance imaging, nuclear scintigra-
phy, or coronary angiography may reveal un-
derlying dilated, hypertrophic or right ventricular
cardiomyopathy, valve disease, or atherosclerotic
heart disease. Further electrophysiological work-
up is often required, and can include a signal
averaged ECG (to detect late potentials) or even
an invasive electrophysiological study in some. In
addition, the baseline ECG may reveal important
underlying causes (hypertrophic cardiomyopathy,
arrhythmogenic right ventricular cardiomyopa-
thy, long QT syndrome, short QT syndrome, or
Brugada-syndrome) and has therefore been rec-
ommended as part of regular screening of athletes
[6]. When no causal therapy is available to prevent
arrhythmia recurrences (as is often the case), and
when the risk of a potentially life-threatening

The author receives an unconditional research grant
for the Electrophysiology Section of the Cardiology
Department of the University Hospital Gasthuisberg
from Medtronic.
Hein Heidbu¨ chel is holder of the AstraZeneca
Chair in Cardiology, University of Leuven.
E-mail address: