A consensus statement with recommendations for drivers with ICDs was presented at the Europace 2009 meeting, in Berlin, Germany on June 21, 2009. Visit the Europace website to read the Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators
MedPage Today, a website for physicians that provides a clinical perspective on breaking medical news, has summarized the guidelines and interviewed Heart Rhythm Society President Richard L. Page, MD, FHRS. » Visit MedPage Today
Page has called the guidelines reasonable but noted that no changes to the AHA/HRS guidelines are expected. AHA/HRS Addendum to Personal and Public Safety Issues Related to Arrhythmias that May Affect Consciousness: Implications for Regulation and Physician Recommendations, issued June 7, 2007 by the American Heart Association and the Heart Rhythm Society, indicated that individuals who receive implantable cardioverter defibrillators (ICD) as a preventative measure don’t need the same driving restrictions as people who get an ICD after surviving a life-threatening heart rhythm disturbance.
For the Europace consensus statement, a team of twelve 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 document.
“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*. “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 and professional driving. Definitions of the European Council Directives (80/1263/EEC) and (91/439/EEC) are used.
- Group 1: drivers of ordinary motor cycles, cars, and other small vehicles with or without a trailer.
- Group 2: drivers of vehicles over 3.5 metric tonnes 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. This resulted in a significant increase in the number of implants. In Western Europe alone, 63,000 ICDs were implanted in 2006 and 85,500 ICDs in 2008.
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. Therefore, driving restriction should be less strict 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,” explained Vijgen.
*Members of the task force include Johan Vijgen (chairperson) Belgium, Gianluca Botto (Italy) , John Camm (United Kingdom), Carl-Johan Hoijer (Sweden), Werner Jung (Germany), Jean-Yves Le Heuzey (France), Andrzej Lubinski (Poland), Tone M. Norekvål (Norway), Maurizio Santomauro (Italy), Martin Schalij (The Netherlands), Jean-Paul Schmid (Switzerland), and Panos Vardas (Greece)
