Sports and HCM – Moving Toward Shared Decision Making

While competitive sports used to be frowned upon in the HCM literature, there is now some evidence that a patient’s risk from exercise is low when they have been implanted with an implantable cardioverter defibrillator (ICD). This feature from Medpage Today gives an overview of contemporary thinking about exercise in HCM patients.

Comprehensive risk assessment, combined with shared decision making around the decision to participate in sports, seems to be the way of the future. This is more fully discussed in the most recent ACC/AHA Guidelines.

However, ICDs should only be implanted if the patient is clearly at risk of sudden cardiac arrest;  they should not be implanted solely for the purpose of allowing a low risk patient to participate in sports.

ICD May Not Bar Competitive Sports

It may be possible for some athletes to continue playing competitive sports despite having an implantable defibrillator according to a recent study published in this week’s Circulation.

The study followed 440 athletes with ICDs who participated in organized sports over a 4 year period. Diagnoses included HCM, Long QT Syndrome, and arrhythmogenic right ventricular cardiomyopathy (ARVC) .  Common sports for the patient-athletes were running, basketball and soccer.

Over the period of the study, 121 of the patient-athletes received a total of 184 shocks:   7% while participating in competition or practice, 5% during other physical activities, and 6% while resting.  No deaths were reported over the approximately 44 months study. “Even though some people did receive shocks while they were participating in sports, no harm came to patients,” said lead author Dr. Rachel Lampert, a professor of internal medicine at Yale School of Medicine.

The study did note that patients with ARVC who engaged in sports were more likely to experience life-threatening ventricular arrhythmias requiring therapy, and, were more likely to receive repeated shocks from their devices.  Hence, competitive sports may be inadvisable for ARVC patients.

For more details about this study, see this story from Health Day News and from Yale News.