Lowering Driving Restrictions After ICD Placement to 3 Months May Be Safe

By Brandon May

December 29, 2021

NEW YORK (Reuters Health) - Driving restrictions after implantable cardioverter defibrillator (ICD) placement could be safely lowered from six to three months, new research suggests.

An analysis of data from more than 700 patients revealed that the cumulative incidence of arrhythmic syncope resulting in sudden cardiac incapacitation fell to less than 0.5% between 91 and 180 days after ICD insertion.

Most industrialized countries recommend a course of driving restrictions lasting six months after implantation of an ICD, Dr. Christian Steinberg of the University Institute of Cardiology and Respirology of Quebec, Canada, and colleagues note in Circulation. Patients are prohibited from driving their private vehicle during this period and are considered "disqualified" from operating commercial vehicles indefinitely.

But according to Dr. Steinberg and his colleagues, the risk of recurrent arrhythmia has not been studied in contemporary ICD cohorts. To bridge this research gap, the team conducted a retrospective analysis of 721 patients from three Canadian tertiary-care centers who received ICD implants for secondary prevention between 2016 and 2020. Patients were followed over a median of 760 days.

In this cohort, the risk of recurrent ventricular arrhythmia was 34% during the three-month period after ICD insertion and decreased to 11% between three and six months and 12% between six to 12 months.

Incidence rates of recurrent ventricular arrhythmia 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 insertion (P<0.001). Patients with ischemic cardiomyopathy more frequently experienced recurrent ventricular arrhythmia compared with patients with nonischemic cardiomyopathy.

During follow-up, the cumulative incidence rate of arrhythmic syncope was 5%, with 58% of arrhythmic syncopes occurring within the first year of ICD insertion. Within the first 90 days, the cumulative incidence of arrhythmic syncope that led to sudden cardiac incapacitation was 1.8%, but this rate decreased to 0.4% between 91 and 180 days (P<0.001).

"Based on the data from the Canadian study, patients could resume driving mostly within 3 months after 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 shortening these private driving restrictions could significantly improve patients' quality of life and independence.

"Social implication from the safety standpoint is minimal since the rates are very low," he said. "Social implications (of) shortening restriction might be rather positive as it helps these individuals come back to full capacity of their social and professional life."

Dr. Steinberg was unavailable for comment.

SOURCE: https://bit.ly/3eq1mkg Circulation, online December 16, 2021.