[Sports activity and implantable cardioverter-defibrillator: when is it still possible? A document of the Italian Society of Sports Cardiology (SIC Sport)]

The issue of sports participation in athletes with an implantable cardioverter-defibrillator (ICD) has gained increasing attention. Contrary to what is often reported by the media, in Italy there is no absolute ban on competitive sports for individuals with an ICD: according to the 2023 COCIS guidelines, eligibility is determined not by the device itself, but by the underlying heart disease and the type of sport practiced. This document reviews the main international (AHA/ACC, ESC, HRS) and Italian guidelines, emphasizing that the indication for ICD implantation must follow the same criteria used for the general population, without considering the desire to practice sports as a determining factor. It then discusses the conditions under which, in Italy as well, athletes with an ICD may be allowed to return to competitive sports. Available evidence, including data from international registries, shows that sports participation in ICD carriers can be safe if performed under specialist supervision, although the risk of appropriate shocks is not negligible. This document also examines the advantages and limitations of different device types and proposes a flow-chart for ICD programming and follow-up, both at baseline and during exercise testing. Finally, it reaffirms that properly prescribed and monitored physical activity remains recommended for patients with ICDs due to its clinical and psychological benefits.