Most industrialized nations’ regulatory bodies suggest a 6-month limitation on private driving after the implantation of secondary prevention implanted cardioverter-defibrillator (ICD). The driving limitations caused major annoyance and societal consequences. For a study, researchers sought to determine the prevalence of suitable device therapy in current beneficiaries of a secondary prevention ICD. Between 2016 and 2020, patients with new secondary prevention ICD implants were recruited in the retrospective analysis at three tertiary care facilities.

About 721 individuals were tracked for a median of 760 days (324, 1,190 days). The incidence of recurrent ventricular arrhythmia was greatest (34.4%) during the first three months following device placement and gradually declined (10.6% between 3 and 6 months, 11.7% between 6 and 12 months). The incidence rate per 100 patient-days following ICD implantation was 0.48 (95% CI, 0.35–0.64) at 90 days, 0.28 (95% CI, 0.17–0.45) at 180 days, and 0.21 (95% CI, 0.13–0.33) between 181 and 365 days (P<0.001). The cumulative incidence of arrhythmic syncope resulting in rapid cardiac incapacitation was 1.8% within the first 90 days, then reduced to 0.4% between 91 and 180 days (P<0.001).

The incidence rate of acceptable treatments leading to abrupt cardiac incapacity in modern receivers of a secondary prevention ICD was substantially lower than previously recorded and decreased dramatically after the first three months. Therefore, driving limitations should be reduced to three months following the index cardiac event, and existing rules should be revised in nations that still use a six-month timeframe. In addition, existing limits on private driving after secondary prevention ICD installation should be revisited.

Reference:www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056471