MOTOR-VEHICLE ACCIDENTS IN PATIENTS WITH AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Objectives. This study was designed to examine driving safety in patie nts at risk for sudden death after implantation of a cardioverter defi brillator. Background. Cardioverter-defibrillators are frequently im p lanted in patients at high risk for sudden death. Despite concern abou t the safety of driving in these patients, little is known about their actual motor vehicle accident rates. Methods. Surveys were sent to al l 742 physicians in the United States involved in cardioverter-defibri llator implantation and follow-up. Physicians were questioned about nu mbers of patients followed up, numbers of fatal and nonfatal accidents , physician recommendations to patients about driving and knowledge of state driving laws. Results. Surveys were returned by 452 physicians (61%). A total of 30 motor vehicle accidents related to shocks from im plantable defibrillators were reported by 25 physicians over a 12-year period from 1980 to 1992. Of these, nine were Fatal accidents involvi ng eight patients with a defibrillator and one passenger in a car driv en by a patient. No bystanders were fatally injured. There were 21 non fatal accidents involving 15 patients, 3 passengers and 3 bystanders. The estimated fatality rate for patients with a defibrillator, 7.5/100 ,000 patient years, is significantly lower than that for the general p opulation (18.4/100,000 patient-years, p < 0.05). The estimated injury rate, 17.6/100,000 patient-years, is also significantly lower than th at for the general public (2,224/100,000 patient-years, p < 0.05). Onl y 10.5% (30 of 286) of all defibrillator discharges during driving res ulted in accidents. Regarding physician recommendations, most physicia ns (58.1%) ask their patients to wait a mean (+/-SD) of 7.3 +/- 3.4 mo nths after implantation or a shock before driving again. Conclusions. The motor vehicle accident rate caused by discharge from an implantabl e cardioverter defibrillator is low. Although restricting driving for a short period of time after implantation may be appropriate, excessiv e restrictions or a total ban on driving appears to be unwarranted.