Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Québec, Canada.
Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2020 Aug;36(8):1269-1277. doi: 10.1016/j.cjca.2020.05.029. Epub 2020 May 28.
Current guidelines recommend 4 weeks of private driving restriction after implantation of a primary-prevention implantable cardioverter-defibrillator (ICD). These driving restrictions result in significant inconvenience and social implications. Advances in medical treatment and ICD programming have lowered the overall rate of device therapies. The objective of this study was to assess the incidence of ICD therapies at 30, 60, and 180 days after implantation.
Driving Restrictions and Early Arrhythmias in Patients Receiving a Primary-Prevention Implantable Cardioverter-Defibrillator (DREAM-ICD) was a retrospective cohort study conducted at 2 Canadian university centres enrolling patients with new implantation of a primary-prevention ICD. Device programming was standardised according to current guidelines. A total of 803 patients were enrolled.
The cumulative rates of appropriate ICD therapies at 30, 60, and 180 days were 0.12%, 0.50%, and 0.75%, respectively. There was no syncope during the first 6 months. The median duration to the first appropriate ICD therapy was 208 (range 23-1109) days after implantation. The rate of inappropriate ICD therapies at 30 days was only 0.2%. Overall, < 13.6% of all appropriate ICD therapies occurred within the first 6 months after implantation.
The rate of appropriate ICD therapies within the first 30 days after device insertion is extremely low in contemporary primary prevention cohorts with guideline-concordant device programming. There was no increased risk for ventricular arrhythmia early after ICD insertion. The results of DREAM-ICD suggest the need for a revision of the existing driving restrictions for primary-prevention ICD recipients.
目前的指南建议在植入一级预防植入式心律转复除颤器（ICD）后限制私人驾驶 4 周。这些驾驶限制会带来很大的不便和社会影响。医疗技术和 ICD 编程的进步降低了设备治疗的总体发生率。本研究的目的是评估植入后 30、60 和 180 天 ICD 治疗的发生率。
在加拿大的 2 个大学中心进行了一项回顾性队列研究，名为“接受一级预防植入式心律转复除颤器的驾驶限制和早期心律失常（DREAM-ICD）”，该研究纳入了新植入一级预防 ICD 的患者。根据当前指南对设备编程进行了标准化。共纳入 803 例患者。
植入后 30、60 和 180 天的适当 ICD 治疗累积发生率分别为 0.12%、0.50%和 0.75%。前 6 个月内没有发生晕厥。首次适当 ICD 治疗的中位时间为植入后 208（范围 23-1109）天。植入后 30 天的 ICD 治疗不适当率仅为 0.2%。总的来说，<13.6%的适当 ICD 治疗发生在植入后 6 个月内。
在符合指南的设备编程的当代一级预防队列中，植入后 30 天内适当 ICD 治疗的发生率极低。ICD 植入后早期发生室性心律失常的风险没有增加。DREAM-ICD 的结果表明，需要修订一级预防 ICD 接受者的现有驾驶限制。
