Curtis A B, Conti J B, Tucker K J, Kubilis P S, Reilly R E, Woodard D A
Department of Medicine, University of Florida, Gainesville 32610, USA.
J Am Coll Cardiol. 1995 Jul;26(1):180-4. doi: 10.1016/0735-1097(95)00133-k.
This study was designed to examine driving safety in patients at risk for sudden death after implantation of a cardioverter-defibrillator.
Cardioverter-defibrillators are frequently implanted in patients at high risk for sudden death. Despite concern about the safety of driving in these patients, little is known about their actual motor vehicle accident rates.
Surveys were sent to all 742 physicians in the United States involved in cardioverter-defibrillator implantation and follow-up. Physicians were questioned about numbers of patients followed up, numbers of fatal and nonfatal accidents, physician recommendations to patients about driving and knowledge of state driving laws.
Surveys were returned by 452 physicians (61%). A total of 30 motor vehicle accidents related to shocks from implantable defibrillators were reported by 25 physicians over a 12-year period from 1980 to 1992. Of these, nine were fatal accidents involving eight patients with a defibrillator and one passenger in a car driven by a patient. No bystanders were fatally injured. There were 21 nonfatal accidents involving 15 patients, 3 passengers and 3 bystanders. The estimated fatality rate for patients with a defibrillator, 7.5/100,000 patient-years, is significantly lower than that for the general population (18.4/100,000 patient-years, p < 0.05). The estimated injury rate, 17.6/100,000 patient-years, is also significantly lower than that for the general public (2,224/100,000 patient-years, p < 0.05). Only 10.5% (30 of 286) of all defibrillator discharges during driving resulted in accidents. Regarding physician recommendations, most physicians (58.1%) ask their patients to wait a mean (+/- SD) of 7.3 +/- 3.4 months after implantation or a shock before driving again.
The motor vehicle accident rate caused by discharge from an implantable cardioverter-defibrillator is low. Although restricting driving for a short period of time after implantation may be appropriate, excessive restrictions or a total ban on driving appears to be unwarranted.
本研究旨在调查植入心脏复律除颤器后有猝死风险的患者的驾驶安全性。
心脏复律除颤器常用于猝死高危患者。尽管人们担心这些患者的驾驶安全，但对他们实际的机动车事故发生率知之甚少。
向美国所有742名参与心脏复律除颤器植入及随访的医生发送调查问卷。询问医生随访患者的数量、致命和非致命事故的数量、医生对患者驾驶的建议以及对州驾驶法规的了解情况。
452名医生（61%）回复了调查问卷。在1980年至1992年的12年期间，25名医生共报告了30起与植入式除颤器电击有关的机动车事故。其中，9起是致命事故，涉及8名植入除颤器的患者和1名由患者驾驶的汽车中的乘客。没有旁观者因事故致命。有21起非致命事故，涉及15名患者、3名乘客和3名旁观者。植入除颤器患者的估计死亡率为7.5/100,000患者年，显著低于普通人群（18.4/100,000患者年，p<0.05）。估计受伤率为17.6/100,000患者年，也显著低于普通公众（2,224/100,000患者年，p<0.05）。驾驶期间所有除颤器放电中只有10.5%（286次中的30次）导致事故。关于医生的建议，大多数医生（58.1%）要求患者在植入或电击后平均等待7.3±3.4个月再重新驾驶。
植入式心脏复律除颤器放电导致的机动车事故发生率较低。虽然植入后短时间内限制驾驶可能是合适的，但过度限制或完全禁止驾驶似乎没有必要。
