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Driving Restrictions After Implantable Cardioverter Defibrillator Implantation: An Evidence-Based Approach
Study Questions:
What is the risk of driving after implantation of an implantable cardioverter-defibrillator (ICD)?
Methods:
An ICD was implanted in 2,786 patients (mean age 61 years). The median follow-up was 33.2 months. The ICD was for primary prevention of sudden death (SD) in 62% of patients. The risk of harm (RH) to others from driving was calculated based on the proportion of time spent driving, whether the patient was a commercial or noncommercial driver, the annual risk of sudden cardiac incapacitation, and the probability of a fatal or injury-producing accident. The cut-off for an acceptable RH was an annual risk of death or injury to others of 5/100,000 (0.005%).
Results:
The annual RH exceeded 5/100,000 in commercial drivers, regardless of whether the ICD was for primary or secondary prevention of SD. The annual RH was <5/100,000 after implantation and after an inappropriate shock in noncommercial drivers who received the ICD for primary or secondary prevention of SD. The RH increased for 2 months after an appropriate shock when the ICD was for primary prevention and for 4 months when the ICD was for secondary prevention of SD.
Conclusions:
The authors concluded that RH after ICD implantation is acceptable in noncommercial drivers, but not commercial drivers.
Perspective:
The RH is higher in commercial drivers due to the much larger average vehicle size and the greater proportion of time spent driving. The results of this study validate the National Transportation and Safety Board practice of denying a commercial license to all recipients of an ICD. The results also validate the recommendation of the American Heart Association that patients not drive for 6 months after an appropriate shock.
Keywords: Follow-Up Studies, Transportation, Death, Sudden, Cardiac, Defibrillators, Implantable, United States
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