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Driving Restrictions After Ventricular Tachyarrhythmia

Physicians often advise patients who have suffered life-threatening ventricular arrhythmias, particularly those with implantable cardioverter-defibrillators (ICDs), not to drive. In this prospective study, 758 patients, who each had suffered a near-fatal ventricular arrhythmia, completed anonymous questionnaires (about driving) a median of 9 months after enrollment in the randomized Antiarrhythmics Versus Implantable Defibrillators (AVID) trial; follow-up questionnaires were completed every 6 months.

Of 627 patients who had driven during the year before the index arrhythmia, 57 percent reported resuming driving within 3 months, 78 percent within 6 months, and 88 percent within 12 months of AVID randomization. Of 403 patients whose physicians had discussed driving, 74 percent had been told not to drive, typically for 6 to 11 months. Of 559 respondents who eventually resumed driving, 2 percent reported syncope while driving, 11 percent dizziness or palpitations necessitating stopping the vehicle, and 22 percent dizziness or palpitations that did not require stopping. Of 295 patients with ICDs who had resumed driving, 8 percent received a shock while driving; no shock precipitated a vehicle accident.

Overall, 55 vehicle accidents occurred among respondents (mean follow-up, 35 months): annual risk for an accident, 3.4 percent; annual risk for an apparently arrhythmia-related accident, 0.4 percent. By comparison, 6.2 percent of patients reported having an accident during the year before the index arrhythmia; the annual accident rate among all U.S. drivers is 7.1 percent. The probability of having an accident was constant over time and did not correlate with duration of abstinence from driving. Accident rates did not differ by randomization (antiarrhythmics vs. ICD).

Comment: These data suggest that driving restrictions may be unnecessary for patients after a life-threatening arrhythmia or an ICD implant. Not only do such patients rarely adhere to restrictions, but, more important, vehicle accidents among these patients are quite rare. Nevertheless, physicians who are thinking about changing their recommendations should not ignore the 2 percent syncope rate while driving found in this study, should become familiar with local laws in the jurisdictions where they practice, and should note that the American Heart Association currently recommends a 6-month wait between ICD implantation and driving resumption.

— H Calkins

Published in Journal Watch Cardiology September 14, 2001

Citation(s):

Akiyama T et al for the Antiarrhythmics Versus Implantable Defibrillators Investigators. Resumption of driving after life-threatening ventricular tachyarrhythmia. N Engl J Med 2001 Aug 9 345 391-397.

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