The electrophysiology team at the Children’s National Heart Institute is raising Children’s National profile as a destination for the diagnosis and treatment of pediatric arrhythmias and congenital heart diseases.
Four physicians acknowledged as national leaders in pediatric electrophysiology — Charles Berul, MD; E. Anne Greene, MD; Jonathan Kaltman, MD; and Jeffrey Moak, MD — are the backbone of the heart rhythm team; and Dr. Berul is current President of the Pediatric and Congenital Electrophysiology Society. The team also includes specially trained pediatric arrhythmia nurses, including one focusing on pediatric syncope.
Children’s National is committed to pediatric heart rhythm disorders research, having served as an enrollment center for investigations, including the Implantable Cardioverter-Defibrillator (ICD) Sports Safety Registry; National Cardiovascular Data Registry ICD Registry™, a database of ICD patients intended to help hospitals track and improve their care; and the Pediatric Lead Extractability and Survival Evaluation study, a multicenter exploration of the durability of ICD leads in young patients.
A Children’s National Health System pediatric cardiologist contributed to a recent study that indicated many children who have implantable cardioverter-defibrillators (ICDs) to treat arrhythmias can safely participate in certain strenuous, competitive sports.
About the Study
Dr. Berul, Co-director of the Children’s National Heart Institute and Chief of Cardiology at Children’s National, along with pediatric and adult cardiology colleagues across the country, kept encountering the same situation: Some patients with ICDs ignored medical guidelines—including those from the American College of Cardiology—and played sports more vigorous than bowling and golf, the games deemed safe for them. No data existed indicating whether higher-intensity sports were dangerous for athletes with ICDs.
“Medical groups advise against individuals with ICDs playing demanding contact sports out of concern the devices might be damaged or not function correctly, or the physiological changes that occur during exercise may exacerbate arrhythmia and cause shocks, resulting in injury to the athlete or others,” Dr. Berul says. “The guidelines are based on assumptions, not data. We needed to gather prospective data on individuals with ICDs who were already participating in vigorous sports to learn if restrictions on certain pursuits are justified.”
Informing the Discussion
Beginning in 2006, Dr. Berul and physicians at nearly 60 sites in North America and Europe enrolled patients with ICDs ages 10–60 who played organized sports in an observational registry called the ICD Sports Safety Registry; North American patients also could self-enroll. Results were reported in “Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators: Results of a Prospective, Multinational Registry,” published this past May in the American Heart Association journal, Circulation.
The study group included 60 college-, high school-, and middle school-age athletes on school-sponsored or traveling teams out of a total of 372 participants. The most common sports in which this subgroup engaged were basketball, soccer, track and field, baseball, and volleyball.
Among the study’s salient findings:
- None of the participants experienced death or injury as a result of sports-related ICD shocks, which occurred during and after practices and games.
- The percentage of participants who received shocks during practices and games matched that of individuals who were shocked during non-organized sports or other physical activities, and overall shock rates were similar to those previously reported for more sedentary individuals with ICDs.
- Zero ICDs failed to correct ventricular arrhythmia during activity.
“In terms of the types of sports represented in our study—not football or ice hockey, whose safety is uncertain—I think we can say the risks of having ICD-associated problems are low,” says Rachel Lampert, MD, associate professor of Medicine at the Yale School of Medicine and lead author of the study. “These data don’t provide individuals blanket permission to participate in sports; rather, they should be taken into account as athletes decide with their physicians and families whether to compete.”
Dr. Berul feels current guidelines do not consider what sports mean to young athletes.
“These data suggest the guidelines are too conservative and don’t take into account the importance of sports to children’s and teenagers’ psychological well-being, as well as the positive effects sports have on many aspects of physical health,” he says. “We must balance those factors against theoretical risk of harm from athletics.”
Read more in the fall 2013 issue of Advancing Pediatrics
. Download the app on iTunes
to receive the latest issue to your iPad.