How Can Athletes Play with ICDs, and What Happens When It Goes Off?

How can athletes play with ICDs – Christian Eriksen, Denmark’s all-time leading scorer in international football, became a global symbol of resilience after collapsing during a Euro 2020 match in June 2021. His sudden cardiac arrest, which left him unconscious on the pitch, was averted by an implantable cardioverter defibrillator (ICD) implanted in his chest. The device, roughly the size of a mobile phone, is now a critical part of his life, allowing him to return to the sport he loves despite the risk of it activating unexpectedly.

The Role of ICDs in Cardiac Emergencies

An ICD is a medical technology designed to monitor and correct heart rhythm abnormalities. It functions by delivering an electric shock to the heart if it detects life-threatening conditions such as ventricular fibrillation or tachycardia. During Eriksen’s collapse, the ICD worked as intended, restoring his heartbeat and enabling emergency responders to stabilize him. The device’s ability to act swiftly in critical moments has made it a lifeline for athletes and patients alike.

“The pacemaker responded as it should,” said Denmark’s national team doctor, Morten Boesen, after Eriksen’s incident. This statement underscores the reliability of ICDs in high-stakes scenarios, though the device’s activation during play remains a source of anxiety for many athletes.

The Debate Over ICDs and Elite Sport

Eriksen’s near-fatal incident sparked renewed discussions about the safety of athletes with ICDs. While some leagues, like Italy’s Serie A, previously barred players with the device from competing, others have adopted more flexible policies. The Premier League and Bundesliga now permit participation, provided athletes undergo rigorous testing to confirm their fitness. This shift reflects evolving medical understanding and the willingness of sports organizations to accommodate players who have proven their ability to manage the condition.

Dr. Amanda Lahti, a sports medicine expert, explains that the decision to return to play is often a collaborative one. “All cases are individual,” she notes. “You gather input from the club, the player, their agent, and medical professionals, weighing the risks against the potential benefits. Ultimately, the athlete has the final say, and they’re rarely willing to step away from the game.” This dynamic highlights the personal sacrifices athletes make to continue their careers, even when the risks are significant.

From Cardiac Arrest to Resuming Play

Eriksen’s journey from cardiac arrest to resuming football began with the implantation of his ICD in 2021. After recovering from the incident, he returned to competitive play with Brentford in the EFL Championship and later joined Manchester United in the Premier League. His case demonstrates that athletes with ICDs can thrive in professional sports, provided they are medically cleared and monitored closely.

“I don’t see any risk, no,” Eriksen told BBC Sport in 2022. “If anything happens, I’m safe.” This sentiment reflects his determination to stay active, even as he acknowledges the device’s life-saving potential.

The Mechanics and Risks of ICDs

ICDs are typically used to treat conditions such as heart failure, coronary artery disease, and arrhythmias. They continuously track the heart’s electrical activity, delivering shocks when necessary. However, the device is not without its challenges. One potential complication is “inappropriate shocks,” where the ICD misinterprets normal heart rhythms and triggers an unnecessary response. Such incidents can be startling, even for those accustomed to the device’s presence.

“I was on stage, talking about the device ironically, when it went off,” recalls James Taylor, a former England cricketer who received an ICD at 26 after being diagnosed with a genetic heart condition. “It felt like a mini explosion in my chest. I was conscious but couldn’t remember much afterward. The body reacts instantly, and you’re left wondering if you’ll survive.”

Real-Life Impacts of ICD Activations

Taylor’s experience is a testament to the ICD’s effectiveness, even when it activates during moments of surprise. While the device’s shock is designed to be lifesaving, it can also disrupt an athlete’s focus or performance. For instance, during a holiday trip to Antigua, his ICD mistakenly detected a heart rate of 500 beats per minute, when in reality, it was the pool pump’s motor. “The ICD picked up a rhythm it thought was mine, but it was actually the machine,” Taylor explained. “It still worked, though—saving me from a more serious situation.”

Evolution of Medical Guidelines in Sports

Over the years, the approach to ICDs in sports has transformed. In the early 2000s, athletes were often advised to stop playing entirely after being fitted with the device. However, as technology advanced and more data emerged, this strict stance softened. “Around the millennium, everyone was told no,” says Dr. Lahti. “But we saw that athletes who ignored the advice and continued playing were often better off. Many found that the ICD worked even more effectively than anticipated.”

Today, ICDs are regarded as reliable tools that can coexist with athletic activity. While they are not foolproof, their ability to defibrillate quickly and tolerate physical contact makes them a viable option for many elite players. This progress has allowed athletes like Eriksen to not only return to play but to inspire others facing similar challenges.

Embracing the ICD as a Partner in Sport

For athletes, the ICD represents both a burden and a blessing. It’s a reminder of past health crises but also a symbol of their ability to overcome them. “Rather than being scared, it’s about treating it as a friend,” Taylor emphasizes. “It’s there to help, and that’s what matters most.” His perspective aligns with the broader view that ICDs are essential for managing cardiac risks without completely limiting a player’s career.

Eriksen’s story, in particular, has become a case study in the balance between risk and reward. After his initial collapse, he underwent a thorough medical evaluation and was given the green light to play. His success in the Premier League has reinforced the belief that with proper monitoring, athletes with ICDs can continue to compete at the highest level. However, the unpredictability of the device remains a critical factor in their decision-making process.

As football and other sports continue to evolve, so too does the integration of medical technology into athletic performance. ICDs have become a standard part of care for high-risk athletes, offering a lifeline while allowing them to pursue their passion. The journey from cardiac arrest to playing again is not without challenges, but it underscores the resilience and adaptability of modern sports medicine. For Eriksen and others like him, the ICD is more than a medical device—it’s a bridge between life and sport, a tool that enables them to keep playing, even in the face of uncertainty.