[Driving restrictions for arrhythmia patients--with special reference to the implantable cardioverter/defibrillator].

UNLABELLED

The series "Illness and Vehicular Traffic", published by the German Federal Ministry for Transportation, has set forth the following guidelines on the subject of driving for patients with cardiac rhythm disorders: "Anyone suffering from disorders of cardiac rhythm which might, on occasion, lead to the repeated interruption of oxygen supply to the brain and thus cause disturbances in consciousness or even loss of consciousness, must be considered unsuitable for driving a motor vehicle of any class." While these guidelines are essentially indisputable, it remains unclear how they affect patients with an implantable cardioverter/defibrillator (ICD). The issue is further complicated by the fact that these patients, as a rule, suffer from malignant and life-threatening cardiac rhythm disorders, often owing to a severe cardiac disorder (primarily coronary heart disease and cardiomyopathy). It was the purpose of a recent study to investigate how medical permission to drive in ICD patients is handled in various European countries. A specifically designed questionnaire was addressed to 46 European National Delegates of the Working Groups on Cardiac Pacing in order to determine their present practices and criteria utilized when advising driving restrictions to patients (pts) after ICD implantation.

RESULTS

Of the 39 (83%) respondents, 22 (56%) cardiologists advised all pts to abstain from driving. Permanent driving abstinence was advised by 13 (33%) of the responding cardiologists, while temporary driving abstinence for periods of 3 to 18 months (mean 9 +/- 4 months) was recommended by 26 (67%) physicians. Criteria for subsequently advising a longer period of driving abstinence were: presyncope by 15 (38%), syncope by 13 (33%) and multiple shocks by 2 (5%) cardiologists. Despite medical advice not to drive, about one-third of pts resume driving. About half of the pts resumed driving after 6 months, with the vast majority driving 12 months after ICD implantation. Two pts experienced ICD discharges while driving, but no motor vehicle accident occurred. One patient had a motor vehicle collision with a fatal outcome which was not caused by loss of consciousness or ICD discharge.

CONCLUSIONS

1. Fatal accidents of ICD discharges while driving are a rare finding in ICD pts. 2) About half of the physicians always advise their pts to cease driving for a period of 9 +/- 4 months. Despite this medical advice pts resume driving 6 months after ICD implantation. 3) Criteria used in advising driving abstinence are not uniform among physicians. In symptomatic bradyarrhythmias the driving privilege may be reinstated after pacemaker implantation provided that symptoms resulting from the interruption of the oxygen supply to the brain have not recurred.