Medical Technology

It could be safe to reduce restrictions on driving for 3 months following ICD.

NEW YORK (Reuters Health) A restriction on driving after implantable cardioverter defibrillator (ICD) placement could be safely lowered from six to three months, new research suggests.

Analysing data from over 700 patients revealed that the cumulative incidence rate of arrhythmic syncope resulting in sudden cardiac incapacitation was less than 0.5 percent from 91 to 180 days after ICD placement.

The majority of industrialized countries recommend a course of driving restrictions that last six months following the implantation of an ICD, Dr. Christian Steinberg of the University Institute of Cardiology and Respirology of Quebec, Canada, and colleagues have noted in Circulation. Patients are forbidden from driving their personal vehicle during this period and are considered “disqualified” from operating commercial vehicles for a long time.

Dr. Steinberg and colleagues claim that the risk of recurrent arrhythmia in current ICD cohorts has not been investigated. To fill this gap in research, the team conducted a retrospective review of 721 patients from three Canadian tertiary-care centers who received ICD implants to prevent secondary arrhythmias between 2016 until 2020. Patients were monitored for an average of 760 consecutive days.

In this study the risk of recurrent ventricular arrhythmias was 34% in the period of three months following ICD placement, and then decreased to 11% between three and six months. It was 12 percent from six to 12 months.

Incidence rates of recurrent arrhythmias ventricular per 100 patient-days were 0.48 at 90 days, 0.28 at 180 days and 0.20 at 181 to 365 days following ICD introduction (P<0.001). Patients suffering from ischemic heart disease are more likely to suffer an arrhythmia ventricular recurrently than patients with nonischemic cardiomyopathy.

In the follow-up period, the cumulative incidence of arrhythmic syncope was 5%, with 58% of syncopes with arrhythmia occurring within the first year following ICD introduction. The incidence rate for arrhythmic syncope leading to sudden cardiac arrest was 1.8 percent within the first 90 days. However the rate fell to 0.4% between 91-180 days (P0.001).

“Based on the results of the Canadian study, patients may resume driving within three months following the implant for secondary prevention or after appropriate ICD shock,” said Dr. Wojciech Zareba, a professor of medicine (cardiology) of the University of Rochester Medical Center, in Rochester, New York.

In an email to Reuters Health, Dr. Zareba who wasn’t involved in the study, said cutting down on these private driving restrictions could significantly improve patients’ living conditions and independence.

He stated that there is little social implication from a safety standpoint because the rates are so low. “Social implications (of) cutting down on restriction may be rather positive as it helps these individuals return to full-time participation of their professional and social life.”

Dr. Steinberg was unavailable for comment.

SOURCE: Circulation, online December 16, 2021.

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