Staples John A, Daly-Grafstein Daniel, Robinson Isaac, Khan Mayesha, Hawkins Nathaniel M, Chan Herbert, Erdelyi Shannon, Steinberg Christian, Maclure K Malcolm, Krahn Andrew D, Brubacher Jeffrey R
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Clin Electrophysiol. 2025 Apr;11(4):801-814. doi: 10.1016/j.jacep.2024.12.002. Epub 2025 Jan 29.
Limited empirical evidence informs fitness-to-drive recommendations after implantable cardioverter-defibrillator (ICD) implantation. Cohort designs can be deceptive because ICD recipients differ from control individuals and may temporarily cease driving after implantation.
This study sought to generate evidence to inform medical driving restrictions after ICD implantation.
We used population-based data to identify all drivers involved in a serious motor vehicle crash in British Columbia, Canada, from 1997 to 2019. Exposure was defined as ICD implantation in the 6 months before a crash. One analysis used a case-crossover design to control for relatively fixed individual characteristics like driving experience. Another analysis used a responsibility design to account for road exposure (miles of driving per week). Both analyses used logistic regression with adjustment for potential confounders.
In the case-crossover analysis of crash-involved ICD recipients, ICD implantation occurred in 212 of 3,299 precrash intervals and in 485 of 6,598 control intervals, suggesting no temporal association between ICD implantation and subsequent crash (6.4% vs 7.4%; adjusted OR [aOR]: 0.86; 95% CI: 0.71-1.03; P = 0.11). In the analysis of all crash-involved drivers with determinate crash responsibility, 14 of 22 drivers with recent ICD implantation and 532,741 of 1,035,433 drivers without recent ICD implantation were deemed responsible for their crash, suggesting no association between ICD implantation and crash responsibility (crude proportion responsible, 64% vs 51%; aOR: 2.20; 95% CI: 0.94-5.30; P = 0.08).
The 6-month interval after ICD implantation is not associated with increased odds of crash nor with increased likelihood of crash responsibility. Contemporary driving restrictions in the first weeks after ICD implantation appear to adequately mitigate the potential increase in crash risk.
关于植入式心脏复律除颤器（ICD）植入后适合驾驶的建议，经验证据有限。队列设计可能具有欺骗性，因为ICD接受者与对照个体不同，并且在植入后可能会暂时停止驾驶。
本研究旨在提供证据，为ICD植入后的医疗驾驶限制提供参考。
我们使用基于人群的数据，识别出1997年至2019年在加拿大不列颠哥伦比亚省发生严重机动车碰撞事故的所有驾驶员。暴露定义为碰撞前6个月内植入ICD。一项分析采用病例交叉设计，以控制驾驶经验等相对固定的个体特征。另一项分析采用责任设计，以考虑道路暴露情况（每周驾驶里程）。两项分析均使用逻辑回归，并对潜在混杂因素进行调整。
在对涉及碰撞的ICD接受者的病例交叉分析中，3299个碰撞前时间段中有212个发生了ICD植入，6598个对照时间段中有485个发生了ICD植入，这表明ICD植入与随后的碰撞之间没有时间关联（6.4%对7.4%；调整后的比值比[aOR]：0.86；95%置信区间：0.71-1.03；P=0.11）。在对所有确定碰撞责任的涉及碰撞的驾驶员的分析中，22名近期植入ICD的驾驶员中有14名以及1035433名近期未植入ICD的驾驶员中有532741名被认为对其碰撞负责，这表明ICD植入与碰撞责任之间没有关联（粗略责任比例，64%对51%；aOR：2.20；95%置信区间：0.94-5.30；P=0.08）。
ICD植入后的6个月间隔与碰撞几率增加或碰撞责任可能性增加无关。ICD植入后最初几周的当代驾驶限制似乎足以减轻碰撞风险的潜在增加。
