Sporting Careers After ICD Implantation in Elite Athletes

Abstract

Background: The use of implantable cardioverter defibrillators (ICDs) in elite athletes following sudden cardiac arrest (SCA) or the diagnosis of high-risk cardiac conditions presents a complex interplay of medical, psychological, and legal challenges. Despite evolving guidelines, data on clinical outcomes and return-to-sport (RTS) trajectories in elite athletes remain limited. Objective: To describe the clinical profiles, management strategies, and career outcomes of elite athletes who received ICDs. Methods: A retro spective multilingual media and literature search was performed up to January 2026 to identify elite athletes with ICDs. Inclusion criteria required evidence of professional or Olympic-level competition, confirmed ICD implantation, and sufficient clinical and ca reer data. Cases were analyzed for demographics, underlying diagnosis, prevention type, post-ICD outcomes, and RTS status. Results: Thirty-seven elite athletes were identified (mean age 25.8 ± 4.3 years). The most common sport was football (n = 25). Hypertrophic cardiomyopathy, non-ischemic LV scar, and arrhythmogenic cardiomyopathy were the most frequent diagnoses, although 49% of etiologies remained unspecified. ICDs were implanted for secondary prevention in 70% of cases. Following ICD implantation, 25 athletes (68%) completed RTS, including 24 (65%) at the professional level. Among these, nine experienced shocks, and four ultimately discontinued competition. The sole fatality occurred in an athlete who had voluntarily explanted the ICD. Conclusions: A substantial proportion of elite athletes with ICDs successfully return to high-level sport, but clinical outcomes, risk tolerance, and legal frameworks remain variable. These findings support continued shifts towards personalized shared decision making and highlight the need for standardized, sport-specific RTS protocols, long-term registries, and psychosocial support in this population.