New European ICD consensus statement includes driving restrictions

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Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car, according to consensus statement presented at a press conference Sunday at the EUROPACE meeting in Berlin. Driving restrictions are imposed making these recommendations an important guideline for patients.

A team of 12 experts from the European Heart Rhythm Association (EHRA), the Council on Cardiovascular Nursing and Allied Professions in ESC (CCNAP) and the section of cardiac rehabilitation of the European Association of Cardiovascular Prevention and Rehabilitation, reviewed the literature, assessed the risk and issued a consensus statement.

"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," explained Johan Vijgen, chairperson of the task force.

The document presented recommendations for private driving (group 1) and professional driving (group 2). 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.

In Western Europe, 63,000 ICDs were implanted in 2006 and 855,000 in 2008.

Many patients are currently implanted for primary prevention for the 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 for those who have survived a life-threatening arrhythmia, according to the consensus statement.

"Patients and their families should receive adequate discharge education and standardized information on driving recommendations," Vijgen said. "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."

The consensus statement will be published in the June issue of Europace.