Cardiac devices related to the management of cardiac arrhythmias include pacemakers and implantable cardioverter defibrillators (ICDs). In general, a patient carrying one of these devices is more protected against the consequences of an arrhythmia than prior to its implantation.
For this reason, it is important to try to adapt sports practice by considering the risks and benefits and not to speak in a dichotomous way of suitability or restriction.
The presence of a pacemaker does not usually represent an absolute contraindication for competitive sports practice. They should be aware that they are carrying a device and should follow certain precautions (not restrictions) to ensure its proper functioning.
They can lead a normal life and benefit from incorporating a physical exercise program into their daily routine. Among all disciplines, the most suitable are walking, swimming, cycling, yoga and others. There is a risk of affecting the device if they undergo sports with risk of collision, which is preferable to avoid.
In addition, they should postpone the start of sports activities six weeks after the device implantation and after performing a stress test.
Other recommendations to keep in mind are:
- Avoid contact sports.
- Extreme movements of the arm homolateral to the implant.
- Avoid sports with exposure to electromagnetic fields.
- Adjust the device settings and recommend physical activity at an intensity level below the defibrillation threshold heart rate.
What about competitive sports?
There are no major risks for pacemaker wearers either, but it is important to identify three key issues:
- Risk of arrhythmias during exercise. The incidence of cardiovascular events during programmed physical activity programs in the population with coronary artery disease is very low, but patients with ICDs are at increased risk of arrhythmic complications.
- Aerobic response to physical exercise in the ICD population. The effect of physical activity on aerobic capacity in heart failure depends on the intensity of exercise.
- Impact of physical exercise on psychosocial well-being. Anxiety and fear are the dominant psychological manifestations experienced by ICD patients. Restriction of sport is associated with a feeling of lack of capacity and this is one of the most important negative aspects of carrying a pacemaker or ICD.
Athletes with pacemakers or ICDs may be considered suitable for participation in sports with higher static and dynamic components if they are free from requiring ventricular arrhythmia therapy for 3 months.
However, they require appropriate counseling regarding the potential risk of inappropriate shock or trauma related to device activation.
Defibrillation in ICD patients
When there are device failures that cannot prevent cardiac arrest, it is necessary to act according to CPR guidelines. Most current ICDs have transvenous systems that do not interfere with external defibrillation.
However, some older devices may incorporate electrodes or subcutaneous patches in the apical region that may increase external defibrillation thresholds.
Once the problem has been resolved, an arrhythmia specialist or one trained in the handling of these devices should check the functioning of the ICD and the subsequent steps to be taken.