The implantable defibrillator and return to operation of vehicles study

Abstract

We sought to characterise driving habits of contemporary implantable cardioverter defibrillator (ICD) patients. We performed a multicentre prospective observational study of consecutive ICD recipients. Non-commercial drivers with a valid licence were eligible. Patient and ICD data were recorded. All patients completed an anonymous questionnaire regarding their driving habits. Among 275 patients, 25 (9.1) stopped driving permanently after ICD implantation. During a mean follow-up of 26.5 4.5 months, 25.3 of patients received an ICD shock (52.5 appropriate). The median time to first shock was 7.0 (2.5, 17.5) months and was not significantly different between primary and secondary ICD patients. However, shocks (36.5 vs. 21.3, P 0.027) and recurrent shock episodes (17.5 vs. 6.2, P 0.011) were more common in secondary ICD patients. Physician-recommended driving restrictions were not recalled by 37.9 and not followed by 23.0 of patients. Overall, the mean duration of driving abstinence was 2.2 2.9 and 3.6 5.3 months for primary and secondary patients, respectively. Notably, 36.5 of secondary patients drove within 1 month. Eight patients (3.3) received a shock while driving, five of which resulted in road traffic accidents. The annual risk of a shock while driving was 1.5. Patient driving behaviour following ICD implantation is variable, with over one-third not remembering and almost one-quarter not adhering to physician-directed driving restrictions. Over one-third of secondary ICD patients drive within 1 month despite physician recommendations. Further studies are required to establish the optimal duration of driving restriction in ICD recipients.