Transvenous cardiac implantable electronic devices withstand contact sports in an experimental model

Cardiac implantable electronic device (CIED) patients are routinely advised against physical activity with a risk of collision because of expected damage to the implanted device. However, no data support this practice.

Sixteen CIED systems (six pacemakers, six ICD, four CRT-D) from all manufacturers were implanted subcutaneously in a porcine thorax and increasing weights were dropped on the experimental setting. Cardiac implantable electronic device function was analysed in an interactive heart simulator (InterSim III, IB Lang). In a second experiment, forces resulting in irreversible damage were investigated in explanted CIED. No signs of malfunction were seen in any CIED after a total of 256 impacts up to 2000 N. Forces exceeding 1500 N reproducibly led to rib fractures of the porcine thorax, in line with previous reports describing serial rib fractures in humans at similar forces. One IS1/DF1 single-coil implantable cardioverter/defibrillator (ICD) lead was bent after an impact of 900 N; however, no signs of lead malfunction were noted on inspection and fluoroscopy. When testing explanted CIED to failure, only 4 of 16 CIEDs (25%) showed signs of damage on fluoroscopy. Two ICDs were unable to terminate VF despite reporting normal shock impedances before VF induction.

This is the first study to analyse the effects of blunt force trauma on CIED. Our data suggest that CIED systems withstand contact sports impacts, which can result in serial rib fractures in humans. Therefore, general traumatological risks could outweigh the risks of CIED damage in sports with a low risk of collision. If damage is suspected, device interrogation should be performed.