MODIFICATION OF PATIENT DRIVING BEHAVIOR AFTER IMPLANTATION OF A CARDIOVERTER-DEFIBRILLATOR

Driving habits among recipients of ICDs have not been well characteriz ed previously, yet such information may have implications for developm ent of national policy. This study was undertaken to characterize driv ing behavior after defibrillator implantation in our patient populatio n. From 1988-1993, 82 ICDs were implanted at the University of Florida . All patients received defibrillator teaching preoperatively: and pos toperatively with particular emphasis placed on driving restrictions. A standardized questionnaire was developed to ascertain driving behavi or, compliance with restrictions, and occurrence of motor vehicle acci dents following implantation. The patients were divided into two group s according to whether or not they had received a shock from their dev ice since implantation. Group I patients did, and Group II patients di d not. Fifty-two out of 82 (63%, Group I) patients had at least one sh ock. The remaining 30 patients had received no shocks. Mean age and ge nder rr ere no different between the two groups. Mean time since impla ntation was 6 +/- 1.3 years in Group I, compared to 4 +/- 1.5 years in Group II (P = 0.001). Forty-seven out of 52 (90%) and 26 out of 30 (8 7%) in Groups I and II, respectively, resumed driving after defibrilla tor implantation. There was no difference in the amount of time that p assed prior to resumption of driving. Group I patients drove more, 20. 5 +/- 27 miles/day compared to patients in Group II, 8.3 +/- 9.7 miles /day (P = 0.02). No patient experienced device discharge during drivin g; likewise, no patient was involved in a motor vehicle accident secon dary to their device firing. Sixty-seven out of 82 (82%) patients comp lied with the instructions they thought they heard; seven patients in Group I and eight patients in Group II deliberately did not follow our advice. The majority of patients do comply with physician instruction s, although the instructions they remember are not always the instruct ions given. If a national policy is created to prohibit driving after ICD implantation, effective enforcement may be difficult.