To save one life is as if to save the world.

- The Talmud

Should ICD Patients Drive?

A team of 12 experts have released a consensus statement with recommendations for drivers with Implantable Cardioverter Defibrillators (ICDs).

ICD patients have an ongoing risk of sudden incapacitation that may cause harm to others while driving a car, and thus driving restrictions are imposed making these recommendations an important guideline for such patients.

And, recently, a consensus statement with recommendations for drivers with ICDs was presented at a press conference at the Europace 2009 meeting in Berlin, Germany.

Experts from the European Heart Rhythm Association (EHRA), the Council on Cardiovascular Nursing and Allied Professions in ESC (CCNAP) and the Section Cardiac Rehabilitation of the European Association of Cardiovascular Prevention and Rehabilitation, reviewed the literature, assessed the risk, and issued the consensus statement.

“Driving restrictions vary across different countries in Europe. We hope the document may serve as an instrument for European and National regulatory authorities to formulate uniform driving regulations,” said Johan Vijgen, chairperson of the task force.

He added: “Driving restrictions are perceived as difficult for patients and their family and have an immediate consequence for their lifestyle. In addition to the psychological and societal impact, the driving ban may also pose a considerable impact on employment and education and thereby economic status.”

The document presents recommendations for private driving (group 1) and professional driving (group 2).

While the first group includes drivers of ordinary motorcycles, cars, and other small vehicles with or without a trailer, the second group includes drivers of vehicles over 3.5 metric tons or passenger carrying vehicles exceeding eight seats excluding the driver.

Since the introduction of the ICD in the early 1980s, multiple trials have demonstrated the efficacy of ICDs for the prevention of sudden arrhythmic death, which resulted in a significant increase in the number of implants.

Many patients are currently implanted for primary prevention (treatment of patients at risk for life-threatening arrhythmias who have never had sustained ventricular arrhythmias). The risk for sudden incapacitation is lower in these patients.

Thus, driving restriction should be less stricted for these patients, than for patients implanted for secondary prevention (those who have survived a life-threatening arrhythmia).

“Patients and their families should receive adequate discharge education and standardized information on driving recommendations. This should result in a better adherence to the recommendations. It should be emphasized that the risk is mainly a consequence of the underlying condition and not of the presence of the ICD,” said Vijgen.

The consensus statement has been published in Europace, the official journal of the European Heart Rhythm Association. (http://www.escardio.org/communities/ehra/Pages/welcome.aspx).