May 29, 2013

DynaMed EBM Journal Volume 8, Issue 22

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: May 29, 2013

Expiration Date: May 29, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158D


Last week 404 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 243 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Participation in Sports Appears Safe for Most Athletes with Implantable Cardioverter Defibrillators
Reference: Circulation 2013 May 21;127(20):2021

Recommendations from the American College of Cardiology and the European Society for Cardiology caution against participation in vigorous sports in patients with implantable cardioverter defibrillators (ICDs) (J Am Coll Cardiol 2005 Apr 19;45(8):1318, Eur J Cardiovasc Prev Rehabil 2006 Oct;13(5):676). These recommendations have largely been based upon projected risks for adverse events, since little data have been available to assess the actual risks. A recent cohort study followed 372 athletes with ICDs in place who were participating in vigorous sports.

Participants, who ranged in age from 10 to 60 years old (median age 33 years with ICD for median 27 months), were assessed every 6 months during median follow-up of 31 months. 88% of the participants were active in organized sports that included regular practices and competitions with vigorous physical activity (most common sports were running, basketball, and soccer). The others participated in “high-risk” sports (e.g. skiing or surfing) in which injury could result from loss of control. The most common cardiac diagnoses were long QT syndrome (in 20%) and hypertrophic cardiac myopathy (in 17%), and the most common indications for ICD were ventricular fibrillation or cardiac arrest (in 27%) and syncope (in 27%). The primary outcome was serious adverse events during sports or within 2 hours of sports activity. These events included death or externally resuscitated tachyarrhythmia caused by shock failure, incessant ventricular arrhythmia, or pulseless electric activity after shock, and severe injury from shock or from arrhythmia-related syncope that required hospitalization.

There were no primary outcome events during follow-up. Overall, 21% of participants had at least 1 ICD shock, with appropriate shocks in 13% and inappropriate shocks in 11%. The rate of shocks during activity (in 10% during competition or practice and in 8% during other physical activity) were significantly higher than during rest (6%, p < 0.0001). In a subgroup of 60 school and college age competitive athletes, 2 athletes stopped or limited further sports activity on advice from their physicians following shocks during competition or practice. Definite lead malfunction occurred in 13 ICDs, with an estimated 5-year malfunction-free survival of 97%, a rate reported to be similar to that in unselected populations. These data may help inform discussions between clinicians and patients with ICDs who wish to participate in sports.

For more information, see the Implantable cardioverter defibrillator (ICD) topic in DynaMed.

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For more information on this educational activity, see the CME sidebar.

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