Lam. Beauregard et al., PERCEIVED AND ACTUAL RISKS OF DRIVING IN PATIENTS WITH ARRHYTHMIA CONTROL DEVICES, Archives of internal medicine, 155(6), 1995, pp. 609-613
Background: We surveyed patient attitudes about driving and about driv
ing restrictions for patients with automatic defibrillators and pacema
kers, and we assessed risk of arrhythmias occurring during driving. Me
thods: One hundred two patients responded to a questionnaire (57 patie
nts with defibrillators and 45 patients with pacemakers) about driving
habits and opinions on restriction of patients who have devices and w
ant to drive. In addition, the literature was reviewed for approximate
incidences of sudden death and syncopal or nonsyncopal device therapy
to estimate risk while driving of having a defibrillator discharge. R
esults: Thirty-two patients with defibrillators (56%) and 28 patients
with pacemakers (62%) currently drove an average of 196 and 161 km/wk,
respectively. Most patients, felt that driving was a right and 75% fe
lt that restriction imposed a hardship on them. Respondents felt that
common sense, limited distances, or physician input should set driving
limitations. A minority felt that no restrictions should be placed on
these drivers or that they should not drive at all. The risks of sudd
en death and syncopal and nonsyncopal defibrillator discharge were est
imated at 0.0009%, 0.0011%, and 0.0015% per kilometer driven, respecti
vely, based on weekly kilometers and published occurrences of these ph
enomena. Conclusions: Patients perceive that driving is their right an
d that there is a low risk of an arrhythmic event behind the wheel. Th
e estimated risk and published accounts of sudden death support this.
However, concurrent medical problems and stresses imposed by driving m
ay increase risk. The physician must make reasonable recommendations t
o ensure patient and public safety, keeping in mind both state and fed
eral driving regulations and reporting requirements.