Posted on 01/04/2022

Reducing the current 6-month driving restriction following a new implantable cardioverter defibrillator to 3 months may be safe, according to data published in Circulation

“Regulatory authorities of most industrialized countries recommend 6 months of private driving restriction after implantation of a secondary prevention ICD,” Christian Steinberg, MD, of the Institut Universitaire de Cardiologie et Pneumologie de Québec in Quebec, Canada, and colleagues wrote. “These driving restrictions result in significant inconvenience and social implications.”

According to the study, Canadian regulatory authorities have defined the acceptable cutoff value for the annual risk for sudden arrhythmia-related incapacitation while driving, potentially causing harm to other road drivers, as five in 100,000.

The purpose of the retrospective DREAM-ICD-2 study was to evaluate the rate of malignant ventricular arrhythmia, and arrhythmia-related syncope in a cohort of Canadian patients during the 6 months after implantation of a secondary prevention ICD.

Researchers included 721 consecutive patients at three tertiary care centers who received a new secondary prevention ICD from 2016 to 2020 (mean age, 62 years; 79% men). Participants were followed for a median of 760 days.

According to the study, risk for recurrent ventricular arrhythmia was highest in the 3 months after ICD implantation and decreased over time (34.4% from 0-3 months; 10.6% from 3-6 months; 11.7% from 6-12 months).

Researchers reported that this risk correlated to an incidence rate of 0.48 per 100 patient-days at 90 days after ICD implantation (95% CI, 0.35-0.64); 0.28 per 100 patient-days at 180 days (95% CI, 0.18-0.48); and 0.2 per 100 patient-days from 181 to 365 days (95% CI, 0.13-0.31; P < .001).

Moreover, the incidence of arrhythmic syncope resulting in sudden cardiac incapacitation was 1.8% within the first 90 days after ICD implantation and dropped to 0.4% from 91 to 180 days (P < .001).

“Driving restrictions for ICD carriers are necessary to ensure patient and public safety, but those restrictions result ... in significant inconvenience and reduction of quality of life for many ICD carriers with implications for work and income,” the researchers wrote. “In the light of the results of the DREAM-ICD-2 study, we believe that there is a need for a revision of the existing driving restrictions for the use of private vehicles in patients with secondary prevention ICDs. A period of a 3-month driving restriction after ICD insertion for secondary prevention seems to be safe and reasonable for most patients and is already proposed by some countries.”

SOURCE: Scott Buzby, Healio