Return‐to‐play in athletes with transvenous and subcutaneous implantable cardiac defibrillator: A meta‐analysis
Abstract Background Arrhythmia in athletes can be career‐threatening, and those with implantable cardioverter‐defibrillators (ICDs) face significant challenges in returning to play due to concerns about safety, efficacy, and arrhythmic risk. Since the last meta‐analysis, additional studies have been...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-08-01
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| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/joa3.70131 |
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| Summary: | Abstract Background Arrhythmia in athletes can be career‐threatening, and those with implantable cardioverter‐defibrillators (ICDs) face significant challenges in returning to play due to concerns about safety, efficacy, and arrhythmic risk. Since the last meta‐analysis, additional studies have been published, providing updated data that suggest both transvenous and subcutaneous ICDs (S‐ICDs) may allow for a safe return to sports through individualized decision‐making. This meta‐analysis aimed to reassess the safety and efficacy of ICDs in athletes returning to play. Methods A systematic review and meta‐analysis were conducted following the PRISMA guidelines. Six cohort studies including 1183 athletes with ICDs were analyzed, with five of them on transvenous ICDs and one on S‐ICD. Primary outcomes included rates of appropriate and inappropriate shocks, shock‐related physical injury, cardiac adverse events, and sports discontinuation. Subgroup and sensitivity analyses were performed to explore heterogeneity. Results The pooled rate of appropriate shocks was 13% (95% CI 0.11–0.16), while inappropriate shocks occurred in 4% (95% CI 0.02–0.11). No shock‐related physical injuries or cardiac adverse events during or shortly after sports were reported (0%). The rate of sports discontinuation was 2%, increasing to4% after sensitivity analysis. Transvenous ICDs showed lower inappropriate shock rates compared to S‐ICD. Conclusion ICD use in athletes returning to play appears safe, with low adverse event rates and minimal sports discontinuation. These findings support tailored return‐to‐play decisions based on arrhythmia type, ICD programming, and psychological support, aligning with the 2024 HRS Class IIa recommendation. |
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| ISSN: | 1880-4276 1883-2148 |