Implantable Cardioverter Defibrillators in Athletes

Although the 36th Bethesda Guidelines for sports participation recommend that athletes with implanted cardioverter-defibrillators (ICDs) be disqualified from participating in sports, survey information suggests that the majority of athletic individuals with ICDs are actively participating. Outcome data demonstrating the value of ICDs in prolonging life in high-risk populations has been established, but such data may not necessarily apply to the athletic population because of the reliability of the ICD under the extreme conditions of sports participation. Here we discuss the definition of sudden death, sudden cardiac arrest (SCA), and ventricular fibrillation (VF); the epidemiology of sudden death in the general population and in athletes; methods of defibrillation and how they differ from one another; the ICD system, implant technique, and indications for implantation; issues surrounding safety and efficacy of ICDs in athletes; return-to-play considerations; preliminary safety and efficacy data obtained from survey data of those who care for athletes with ICDs; and the rationale for the recently launched ICD Sports Registry.