Exercise in Specific Diseases: Pacemakers and Implantable Cardioverter Defibrillators

Abstract

Expanding guidelines and improved diagnostic/screening techniques have led to an ever-increasing pool of subjects with cardiac implanted electronic devices (CIEDs), including a significant proportion who are young and physically active. Exercise has multiple health benefits, both physical and psychological, and a structured rehabilitation program is advocated for most patients with heart disease. However, the presence of a CIED such as a pacemaker or cardiac defibrillator (ICD) gives rise to specific concerns with regard to exercise, including increased risk for arrhythmia occurrence, syncope, physical injury, appropriate and inappropriate shocks, and device malfunction/damage related to trauma. While high intensity exercise and competitive sports are considered inadvisable in this situation, available evidence suggests that moderate to strenuous exercise and recreational sports can be practiced safely in most individuals. This chapter discusses the main issues with regard to exercise in patients with CIEDs, summarizes available evidence on this topic and aims to provide a practical framework for decision-making for the clinician confronted with this problem.