Perspective:

Since the inception of ICD therapy for secondary prevention, the reported appropriate ICD therapy rates have been declining. While restrictions on driving following implantation of a secondary prevention ICD vary, most jurisdictions require a 6-month period of no driving for personal use (and no driving whatsoever for commercial drivers). Medical society guidelines were developed based on assessments of the risk of harm, with these key components: proportion of time spent driving, type of vehicle driven, yearly risk of sudden cardiac incapacitation, and the probability that incapacitation would result in an accident. The current manuscript shows that the incidence rate of recurrent ventricular arrhythmia resulting in appropriate therapy is low in contemporary ICD recipients. The authors note that after the first 90 days, the overall risk of arrhythmic syncope diminishes significantly. They propose 3 months as the more contemporary standard for driving restriction.