PERCEIVED AND ACTUAL RISKS OF DRIVING IN PATIENTS WITH ARRHYTHMIA CONTROL DEVICES

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.