Las nuevas guías europeas sobre cardiología del deporte y actividad física en personas con problemas cardiológicos han levantado mucho interés, no es para menos. Y uno de los temas por las que más consultas recibimos es en relación con el ejercicio y los marcapasos.
Cada día se implantan más marcapasos, y estas personas nos preguntan si pueden hacer ejercicio, qué tipo de deporte pueden hacer, si es seguro hacerlo, etc. Aquí os dejamos los puntos más destacables que se indican en las guías europeas:
- Las personas portadoras de un marcapasos pueden participar en deportes competitivos o recreativos en ausencia de una enfermedad cardíaca estructural o de otro tipo para la cual el ejercicio puede estar prohibido.
- En las primeras semanas tras la implantación del marcapasos, se deben evitar las actividades deportivas que aumentan el riesgo de dislocación del cable. Es decir, no deben realizar movimientos extremos de los brazos, en concreto en el que está puesto el marcapasos.
- Para una correcta programación y mejorar la actividad, se pueden realizar pruebas de esfuerzo y poner Holter de ECG para conocer cuáles son las frecuencias cardiacas habituales con ejercicio y excluir la aceleración inapropiada de la frecuencia en otras.
- Todas aquellas personas con un dispositivo cardíaco (aquí las guías incluyen los marcapasos, desfibriladores, equipos de terapia de resincronización cardíaca) deben evitar las actividades deportivas asociadas con el riesgo de traumatismo torácico, por el riesgo de disfunción.
- Aquellos deportes con movimientos pronunciados de los brazos (p ej, voleibol, baloncesto, tenis, golf, escalada), pueden aumentar el riesgo de daño tardío del cable debido al aplastamiento repetido y contínuo de la región subclavicular (con aislamiento o fallo del conductor), por ello debemos informar al paciente que lleven cuidado al realizar estas actividades.
- Se recomienda la implantación del marcapasos en el lado contralateral del brazo dominante, es decir, si Ud. es diestro, se debería poner en el lado izquierdo, y viceversa.
- Es recomendable que el marcapasos se coloque debajo del músculo (no sólo debajo de la piel), con fijación dentro del bolsillo que se crea, para mejorar la durabilidad del sistema. No se sabe si las técnicas de implante subcostal o epicárdico proporcionan un beneficio a largo plazo.
- ¿Qué sucede con los equipos de micro-ondas, telefonía móvil, etc.? En este respecto hay que indicar que la interferencia electromagnética es poco probable con los dispositivos modernos y no se han informado casos, pero siempre debe sospecharse y evaluarse de cerca en entornos deportivos específicos con equipos electrónicos. Si esto sucediese, no se preocupe, se puede corregir con una reprogramación adecuada del dispositivo por parte de su cardiólogo.
Así pues, el ejercicio es posible adoptando una serie de cuidados y medidas.
REFERENCIA
- 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)
- Enlace a las Guías Europeas
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