Questions about the specific risks of contact sports (like BJJ) with an ICD

Hi everyone,

I'm new to the forum, but I did my best to look for posts about participating in martial arts, combat sports, and contact sports generally before posting. I have an ICD to shock me if I go into vtach/vfib, and I'd like to get back into activities like weight lifting and Brazilian Jiu Jitsu (BJJ) if I can properly assess the actual risks involved. I know this has been discussed and I apologize for creating yet another thread, but technology changes, research on risks changes, medical advice changes, and the last thread I saw that really got into the questions I have (https://www.pacemakerclub.com/message/26848/brazilian-jiu-jitsu) was posted eight years ago. I don't know how much has changed since then or if having an ICD rather than a pacemaker puts the advice from other, more recent threads in a different light.

I'm in my early 30s and have Brugada Syndrome, which means I'm normally fine but I'm at risk of syncope, ventricular tachycardia, and ventricular fibrillation (and, ultimately, sudden cardiac death). I got a single chamber (i.e., one lead) ICD about a year ago and received some conflicting information from my care team, all the way from saying I have no restrictions after healing to saying I should avoid things like swimming or getting hit in the chest. I wasn't actively training in any martial arts or combat sports at the time, but I used to love them, and I had always planned to return to them when I could. Since I wasn't actively training when I got the diagnosis and ICD, there wasn't a point where I had to confront the prospect of quitting. Recently, though, the prospect of never being able to start training again has been haunting me on a daily basis. It's also contributing to resentment of the things I chose to pursue that caused me to stop martial arts in the first place, which hasn't been helping my career, general wellbeing, or outlook on the future.

Specifically, I would like to figure out how to safely return to basic fitness training (e.g., running, calisthenics, and weightlifting) so that I can get back into shape in order to (hopefully) return to martial arts/combat sports, like BJJ and wrestling. I would also love it if I could train in Muay Thai again, and I've always wanted to try things like judo, sambo, and boxing. As in the thread from eight years ago, the benefits are sort of obvious: these are activities I want to do, participating would motivate me to exercise generally, I'd be more active and fit, I'd get much-needed stress relief, etc. Where I'm stuck is on how to evaluate the risks.

Here are my questions:

1. What are the specific risks associated with an impact directly to the ICD, and do they go beyond temporary pain/bruising?

2. Would one of those pads designed to protect pacemakers/ICDs prevent the potential harms from impacts?

3. Have people been able to safely train and spar in striking arts (like Muay Thai, boxing, etc.) with or without pads to protect their pacemaker/ICD?

4. What are the risks associated with damaging a lead? Can it cause damage to me or even death, or does damaging the lead mean it just needs to be replaced? I'm not being paced, so I'm trying to get clarity about whether the lead itself can cause damage inside my body. I ask because one doctor vaguely alluded to "perforations" as something that can happen with the lead, but didn't explain whether they just meant the lead can become perforated or instead if the lead can perforate me. They also didn't explain the causes or consequences.

5. What kinds of movements cause damage to the leads? There are posts on here claiming that after healing, the lead is firmly in place and probably won't move. A minority of people obviously have damaged leads in the past, so I know it happens. In the case of BJJ, contact/pressure from someone's head, hand, chest, etc., on my chest would be inevitable and sometimes potentially forceful, but a pad seems like a potential solution to that, and people have said on here in previous posts that they are fine with this. On the other hand, there are joint locks that hyperextend the elbow, target the shoulder by twisting the arm behind the back, etc., and I'm worried about whether having my arm extended or twisted could damage or dislodge the lead. I'm also unsure about risks from pushups, pullups, and lifting weights - and, frankly, I still kind of baby my left arm because I really don't know what can go wrong. For context, my ICD is just under the skin below the collar bone on my left side.

6. For those of you that do train in martial arts or combat sports with resisting partners, are you able to participate fully? Do you have to ask people to avoid strikes to the chest or arm locks on a specific side, etc.? Are you able to, say, compete in BJJ tournaments? One doctor told me there are NBA players with ICDs, and they do repetitive movements all the time with their arms, but I don't have their resources and access to medical professionals.

7. For those of you with experience with things like BJJ and muay thai, how have you explained them to your care teams if they don't already know about them?

Thank you for any advice, insight, or encouragement you can offer. I am also trying to communicate more directly with my care team about these things, but I would love to hear from folks here about their experiences, what they've heard from their doctors, how they've communicated with their doctors, etc. The prospect of just being stuck with the career I sacrificed martial arts for and never being able to return to martial arts is really getting me down. I know I could probably do things that don't involve sparring, but that part is important to me.

 


6 Comments

Physical training with ICD

by Old male - 2022-10-09 10:23:16

As an 8 year ICD patient, I easily continued with exercise routine within a gym environment.  Well past the age of setting any new personal records in speed or strength and aware from past experience how easy it is to sustain a painful injury. 

Why would I want to take the chance.  I believe a few basic "Do Not's" were included in post surgery instructions including avoid getting close to strong magnetic fields, avoid direct impacts at device site.  Also, do not use a Jackhammer which I would "guess" could trigger a device response. 

As one having had a couple of shocks (therapy) I would have to wonder if the adrenaline response of sparring might cause a bad rhythm?

There were other instructions but not within my immediate memory.  The whole point seems to be avoid extremes and use common sense.  There is nothing about having an ICD to prevent one from being healthy in general. 

In life, we have to adjust to changing situations for our own good.  Just face it, you can probably train for but your full contact sport participation days are over.  Nothing wrong with having these skills as they might someday be needed to save you in a real life situation.

An Old Perspective

by benedeni - 2022-10-09 10:33:15

I just feel the need to respond to your post though I would be the last to understand all the intricaries of your sports and exercise regime.  All I'm here to say is that life is short enough as it is.  Those of us depending on a device in our chests to maintain that life need to take care of that small miracle at all costs.  As a wife, mother and grandmother approaching the age of 80, I cringe at the thought of you returning to your previous activities.  Sometimes we have to settle for second choices.  Please be careful.  

Fitness / Leads / S-ICD

by JayKay - 2022-10-09 12:01:35

I'm in my mid 30s, have an ICD, and have a condition that is similar to Brugada. Since my arrhythmias occur at rest, running, weightlifting and other adrenaline prone activities are fine/encouraged by my care team. 

Regarding getting back into fitness, I would suggest starting with long walks and see how you feel. In the beginning, I remember being afraid of feeling my heart rate go up. Little by little my confidence grew and now I run multiple miles at a 9 min pace without concern.

As for lifting, I avoid pull-ups and handstand push-ups. My care team didn't say "no you can't do these activities", rather they said everything is a trade off. According to them, pull-ups are more likely to damage/crush the leads. Repeated damage to the leads means they may not work when you need them. As an alternative, they said I could do as many push-ups as I'd like. So, I do multiple sets of 35.

I was also told the leads don't generally just break all the sudden. Rather there is wear over time. If too much wear occurs, a new lead may need to be placed. Since you are younger they may also suggest extracting the damaged lead. All of this to say, damaging a lead = surgery = more scarring which can impact electrical flow through the heart among other things. 
 

Keep talking with your care team and tell them your goals. I actually kinda wonder if an S-ICD implanted in your side/abdomen might work for you since you're not paced. This is just a guess, but it might be worth exploring. That way getting hit in the chest may not really matter.

Jackie

activity

by Tracey_E - 2022-10-09 12:41:35

Odds of breaking a lead are small, but it can happen if we sustain a direct hit that's hard enough at the right angle. More likely, it would wear out more quickly. 

I've always been very active, with my doctor's blessing. Running, paddling, pull ups, barbells- many things that others are sometimes told to avoid. I did Crossfit for 10 years with no ill effects. I stopped because of my back and shoulders, not the pacer. I do Orangetheory now, still a decent worklut and using weights but no more big barbells (giant pout, I love the heavy weights). 

I'm on my 5th pacer. The last one was placed subpectoral and came loose from where it was placed so it poked out a bit. I caught the edge of it while scaling a wall in a Spartan race. OUCH!!! Hurt like he## and was bruised for weeks, but the leads and box were both fine. Now it pokes out even more. So I paid a bit of a price to get that Spartan medal. 

I've always drawn the line at contact sports. Not necessarily for fear of damaging the leads, but because a direct hit HURTS. I was told martial arts are ok but avoid sparring. At the very least get one of the protective shirts. If you read my other posts, you'll see that my doctors are very liberal in their instructions and I tend to push the limits. I would, personally, draw the line at sparring. YMMV. 

If you decide to start with weights, ease into it. If something pulls or doesn't feel right, back off. One thing to avoid, and whether it's an issue or not depends on how your box is placed, is direct pressure on the box/leads. Or if it is just under the collarbone, pressure on the collarbone. This will crush your leads, you don't want that. Mine is lower so the bar isn't anywhere near my leads in front rack. 

Repetitive motion such as weights or rowing can damage leads over time. However, the amount of repetitiion from simply staying fit is not likely to cause problems. It can, we've had a few members who did wear out leads this way, but in general it's considered safe if we aren't training professionally. 

Sparring would be a risk, it's up to you if that risk is worth it. 

Always make sure your doctor knows what you do, even if they may not approve. They can't treat you if they don't have all of the facts.

Have you ever seen an adult congential specialist or a sports cardiologist? They may be better able to give you insight into what it would take to do what you want to do. The average cardiologist does not have more than one or two young active patients. 

Rules

by AgentX86 - 2022-10-09 22:08:48

The relevant rules my EP gave me was "no free weights" and "no contact sports".  Since I was 65, neither were an issue.

I had some other restrictions that, depending on how you look at it, were more restrictive. ...like mowing the lawn. 😁

nobody will give you an answer

by dwelch - 2022-10-14 02:36:07

You are not going to get the answer you want, will just start with that.

You should definitely know/understand that you can hurt the skin/muscle betwee the device and the outside world with contact, can even tear it open, rock and a hard place.  And that leads to immediatly getting to the hospital before your body realizes there is a foreign body and starts to reject it and/or deal with infection which we as patietns with implants should be always on top of anywhere on the body.  

As you have metioned it seems to be very rare that a lead disloges.  It does not take too long to grow scar tissue at the point in the heart, but it also gets attached to the vein that gets it there, removal has going from impossible to dififcult as a result of how your body hangs on to that lead.  You can see in photos how the other end is connected and screwed down on the pacer end.

From a mechanical perspective I think the point where the lead goes into the pacer is the most vulnerable, but in order to get the right force on that spot you would need a very focused hit that would almost have to pierce the skin, think chisel and hammer.  Cant do that with a toe or finger or hand or foot IMO.  Even with the chisel and hammer not sure if the body can push back with the right force....Does this make it impossible?  no.  

Could you dent the device and put the battery or internal pcb at risk?  yeah that might be possible but again I think it would have to be small blunt object, screwdriver turned around handle into pacer, with hammer. not a toe nor finger not a heel nor palm.

IMO as if my opinion counts, is that your highest risk is damage to the skin brusing or tearing the pocket open.

I have taken two very hard hits on my devices over the years and had no issue.  for one I did go see the doc I think and get an interrogation.  But I was feeling fine from a take my pulse for 60 seconds perspective, but not from the it hurts and got a bruise perspective.

could you armor it, a pad is IMO not the best idea it will spread the force out but it will spread it out onto the device you still get that pinch between the device and a hard place, risking damaging the pocket.  It needs to be a device that spreads the force out but also spreads it out above or below to the body away from the device.

If this is a competitive sport and they know you have a weakness and they want to win.  just keep hitting you in the pacer till you give up.   so however you do this, clearly you understand that.

All the other non contact activities, weight lifting, etc, not a problem. I would not even restrict loose weigths, you could just as easily trip and hit your shoulder on the edge of a wall and have the same force as that random weight that might fall once in your life on your device.

At the end of the day no doctor is going to green light this, they wont be a doctor much longer if they were willing to do that.   No pacer company is going to green light this either, they would be opening themselves up for a lawsuit as well.   This is 100% on you, you have to decide yourself i you can do it safely, and you have to decide for yourself what protection.  Most folks with pacers are no longer football, soccer, rugby, etc players.  Many may be backpackers and such, but most of us are beyond contact sports. So I dont expect to find anyone in your specific situation.  They may do martial arts but no tcompetitively, more of the mental and physical side of it. Or perhaps in a studio where drills or competition are such that they honor your pacemaker and do not hit you there.

While the demand for such a device is very very low, with the ease of prototyping today, etc, the design of a protective device is a product you can try to develop.  The one that you sometimes see advertised here, looks to me to be very bad, lets put the force on the lead and see if we can break it and or lets see if we can rip the skin open evenly around the device in one shot, rather than have a wider spread or bigger bridge.   

You know you're wired when...

Your old device becomes a paper weight for your desk.

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As for my pacemaker (almost 7 years old) I like to think of it in the terms of the old Timex commercial - takes a licking and keeps on ticking.