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Background and Purpose: A 1996 AHA statement recommended that people with histories of ventricular tachycardia (VT) or ventricular fibrillation (VF) not drive a motor vehicle for 6 months after the arrhythmic event (Circulation 1996; 94:1147). At that time, nearly all patients with implantable cardioverter-defibrillators (ICDs) had histories of VT or VF, and many laws consequently required patients to wait for 6 months after ICD placement before resuming driving.
Since 1996, ICD indications have been broadened to include primary prevention for a selected, but large and growing, population without prior arrhythmic events (see, e.g., Journal Watch Cardiology Mar 4 2005). However, most legal requirements have not caught up with the medical reality. Therefore, the AHA and HRS have now published a 2007 addendum to the 1996 ICD driving guidelines.
Key Points:
1. All ICD wearers should avoid driving for at least 1 week after ICD placement.
2. After the 1-week wait period, asymptomatic patients who received their ICDs for primary prevention need not have their driving restricted. However, they should be informed that loss of consciousness is possible.
3. Once an ICD that was implanted for primary prevention delivers appropriate therapy for VT or VF, the wearer should be subject to the driving guidelines for secondary-prevention ICDs, especially if symptoms of cerebral hypoperfusion accompanied the arrhythmic episode.
4. The driving guidelines for people with secondary-prevention ICDs still stand.
5. The guidelines for both primary- and secondary-prevention ICDs apply only to private drivers — not to commercial drivers, whose driving activities are appropriately subject to stricter regulations.
6. This AHA/HRS statement does not carry the force of law, for which government entities are obviously responsible.
Epstein AE et al. Addendum to “Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations: A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology.” Public safety issues in patients with implantable defibrillators. A scientific statement from the American Heart Association and the Heart Rhythm Society. Circulation 2007 Mar 6; 115:1170-6.
Comment
This updated AHA/HRS statement weighs the loss of personal autonomy that driving restrictions can impose against the potential risks of driving for ICD wearers and for others on the road. The authors admit that no randomized trial has compared outcomes between ICD wearers who drive and those who do not, but their statement is based upon the best available evidence on risks and outcomes in people with these devices. Given how much ICD indications have changed in recent years, the statement provides welcome clarification of what has been a confusing issue for patients, clinicians, and lawmakers.