Law Ian H, Shannon Kevin
University of Iowa Children’s Hospital, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Pediatr Cardiol. 2012 Mar;33(3):387-93. doi: 10.1007/s00246-012-0167-1.
Since the incorporation of implantable cardioverter-defibrillators (ICDs) into the management of life threatening arrhythmias in the 1980s, tremendous advances in device and lead technology have allowed the implantation of ICD systems in younger and smaller patients. The majority of these young patients with ‘‘electrical’’ cardiac disease and a significant number of those with other indications for ICD placement have near normal to normal cardiac function, which has resulted in a large population of young ICD patients with minimal to no symptoms. This population has pushed the boundaries of published guidelines on activity restrictions for the disease state and the presence of an ICD, creating a dilemma for the patient, the family, and the health care team with regard to which activities should be permitted. Strong evidence suggests that vigorous activity increases the probability of life threatening arrhythmias in the at-risk population. In addition,repetitive training and high levels of exertion may decrease the durability of the ICD system, leading to inappropriate or ineffective device therapy. However, competitive sports promote regular physical activity, even at the novice level, and regular physical exercise confers numerous short- and long-term benefits. The clinician must always balance the potential risk in sports participation for the patient who has an ICD with the documented adverse effects of chronic physical inactivity. The decision to allow sports participation is multifactorial and therefore cannot be made purely on the basis of consensus statements or the patient’s desire to compete.
自20世纪80年代植入式心脏复律除颤器（ICD）被纳入危及生命的心律失常管理以来，设备和导线技术取得了巨大进展，使得ICD系统能够植入更年轻、体型更小的患者体内。这些患有“电气性”心脏病的年轻患者中的大多数，以及大量因其他适应症而植入ICD的患者，其心脏功能接近正常或正常，这导致大量年轻ICD患者症状轻微或无症状。这一人群突破了已发布的关于疾病状态和ICD存在情况下活动限制指南的界限，给患者、家庭和医疗团队带来了一个两难问题，即哪些活动应该被允许。有力证据表明，剧烈活动会增加高危人群发生危及生命的心律失常的可能性。此外，重复训练和高强度运动可能会降低ICD系统的耐用性，导致设备治疗不适当或无效。然而，竞技运动能促进规律的体育活动，即使是在新手水平，而规律的体育锻炼能带来许多短期和长期的益处。临床医生必须始终在ICD患者参与运动的潜在风险与长期缺乏体育活动的已知不良影响之间取得平衡。允许患者参与运动的决定是多因素的，因此不能仅仅基于共识声明或患者的竞争意愿来做出。
