Technical Suitability of Implantable Cardiac Devices for Recreational Diving

Background: Diving is a diffused recreational activity, and the number of divers carrying cardiac implanted devices is similarly growing. Due to the lack of guidelines or technical indications, the suitability of such devices for diving or the fitness to dive for these patients still needs to be determined. Objective: This work summarizes implantable cardiac devices' suitability for recreational diving, technical vulnerability factors, and recommendations to improve implanted divers' safety. Methods: Between May 1, 2021, and March 20, 2022, three interventional cardiologists retrieved the technical documentation of selected implantable cardiac devices. In particular, any suitability and tests conducted in hyperbaric environments were tracked. Results: Technical documentation was recovered for four companies. Most devices were tested in hyperbaric conditions in single, prolonged, or repeated exposures to pressurized air; underwater tests were not mentioned. No company expressly disclosed the suitability of the devices for underwater activities. Conclusion: In the absence of technical indications or guidelines, a multidisciplinary evaluation between cardiology, diving medicine, and sports medicine is essential to establish the suitability for underwater sports in implanted patients. Before each diving trip, device control is advisable, and underwater physiological adaptations should be considered, especially in the cardiovascular domain. Stressors other than water and pressure must be considered during diving, such as lead strain caused by arm movements and pressure exerted by suits or buoyancy control devices on the chest. Future directions point towards a follow-up of implanted, active divers and developing leadless devices and underwater telemonitoring.