592Intensive recreational vs. competitive athletes in the prospective multinational ICD Sports Safety Registry: results from the European recreational cohort

Abstract

Background: In the ICD Sports Safety Registry, death, arrhythmia- or shock-related physical injury did not occur in athletes who continue competitive sports after ICD implantation. However, data from non-competitive ICD recipients who want to engage in intensive recreational sports is lacking. Purpose: To analyse and compare arrhythmic events and lead performance in intensive recreational athletes (vs. competitive athletes) with ICDs, enrolled in the European Recreational arm of the Registry. Methods: The Registry recruited 303 competitive athletes over age 18, receiving an ICD for primary or secondary prevention (221 US; 82 non-US). In Europe and Australia only, an additional cohort of 80 “auto-competitive” recreational athletes was also included, engaged in intense physical activity on a regular basis (≥2x/week and/ or ≥2hours/week) with the explicit aim to improve their physical performance limits. All were followed for a median of 43 months. ICD shock data and clinical outcomes were adjudicated by three electrophysiologists. Results: Compared to competitive athletes, recreational athletes were older (median 44 vs. 39 years; p=0.002), more frequently men (79% vs. 68%; p=0.06), with less idiopathic VF or CPVT (1.3% vs. 14.8%) and less congenital heart disease (1.3% vs. 7.3%)(p<0.001). They more often had a prophylactic ICD implant (51.4% vs. 27.1%; p<0.0001) or were given a beta-blocker (95% vs. 66%; p<0.0001). LV ejection fraction, ICD rate cut-off, and time from implant were similar, and hours of sports per week was identical (median 4.5 vs. 4.4 hours). Fewer recreational athletes participated in sports with burst-performances (vs. endurance) as their main sports: 4% vs. 64% (p<0.0001). None of the athletes in either group died, required external resuscitation, or were injured due to arrhythmia or shock. Freedom from definite or probable lead malfunction was similar (5- year 97% vs. 96%; 10-year 93% vs. 91%). Recreational athletes received fewer total shocks (13.8% vs. 27.1%, p=0.01) due to fewer inappropriate shocks; the proportion receiving appropriate shocks was similar (12.5% vs. 15.8%, p=0.46). Recreational athletes received fewer total (6.3% vs. 20.8%; p=0.002) and appropriate (3.8% vs. 11.6%; p=0.04) shocks during physical activity. VT/VF storms during physical activity occurred in 0/80 vs. 6/ 303 athletes. Shocks during physical activity were related to underlying disease (p=0.007), secondary prevention (p=0.003) and competitive sports (p=0.04), but there was no relation with age, gender, beta-blocker use, or burst/endurance sports. The proportion of athletes who stopped sports due to shocks was similar (3.8% vs. 7.5%, p=0.32). Conclusions: Participants in recreational sports have less frequent appropriate and inappropriate shocks than participants in competitive sports, particularly during physical activity. Shocks did not cause death or injury. Recreational athletes with ICDs can engage in sports without severe adverse outcomes.