Is it safe to drive a car with an Implanted Cardioverter-Defibrillator (ICD)? Many patients ask themselves this question. What do the regulations say? Questions from ICD drivers are answered by dr hab. n. med. Michał Mazurek, expert of the Heart Rhythm Section of the Polish Society of Cardiology.
Before the cardioverter-defibrillator implantation procedure, patients are wondering how the device and the procedure will affect their lives. Will they be able to drive a car? Will their lives change radically? All doubts are dispelled by dr hab. Michał Mazurek.
Can I drive a car with an implantable cardioverter-defibrillator (ICD)?
Yes, and you must! It is difficult not to use the basic achievements of civilization today. The implanted device is supposed to help us in life, protect it, save it at a critical moment, and not be the proverbial "ball and chain" that complicates it to a significant extent.
It is worth remembering that today, before making a decision about implanting a device, patients often make it clear that one of the most important criteria for them is whether they will be able to drive a car after the procedure. In the United States, it is impossible to function normally without a car, and in Poland, a car is now a common means of transport and an increasingly accessible good.
Thus, a possible driving ban may have a direct impact on the patient's decision as to the implantation of the device, and later on his life (education, work, earnings, quality of life, mental state), potentially limiting his autonomy. This, in turn, can lead to non-compliance with doctors' recommendations.
Is there a risk?The risk always exists - patients with cardioverter-defibrillator are exposed to the so-called "Sudden incapacitation" associated with the possibility of a life-threatening ventricular arrhythmia that can lead to haemodynamic instability (drop in blood pressure, fainting, and even sudden death).
It could be the cause of a road accident. In Canada, a number of scientific studies have been conducted which estimated the risk of harming (themselves and others) by a person with a cardiac disease and an implanted cardioverter-defibrillator. Inthe research took into account several key parameters, such as:
- time behind the wheel (private versus professional drivers)
- type of car (passenger car, truck, etc.)
- annual risk of so-called "sudden incapacitation" (as defined above and depending on the underlying disease)
- probability of causing "sudden incapacitation" of an accident, which may lead to personal injury or death of people involved in the accident.
Based on these factors, a mathematical formula was created, on the basis of which it was established that the socially acceptable annual risk of causing harm to other people by a driver with a defibrillator-cardioverter must not be higher than 0.005%.
Cardioverter-defibrillator (ICD): driving restriction
| Type of sudden cardiac death prevention | Private driver | Professional driver | |
| ICD implantation | primary | 1 month | permanent |
| secondary | 3 months | permanent | |
| ICD replacement | primary | 1 week | permanent |
| secondary | 1 week | permanent | |
| Replacing the ICD electrode | primary | 1 month | permanent |
| secondary | 1 month | permanent | |
| Type of ICD therapy | Private driver | Professional driver | |
| ICD therapy | adequate | 3 months | permanent |
| inadequate | until the problem of inadequate therapies is resolved | permanent |
What does primary or secondary prevention of sudden cardiac death mean?
Sudden cardiac death is most often caused by persistent, haemodynamically unstable (leading to unconsciousness) ventricular tachycardia or ventricular fibrillation. If a patient has had an episode of life-threatening ventricular arrhythmia, for example has a history of cardiac arrest and successful resuscitation, we treat him as a patient in the so-called secondary prevention of sudden cardiac death.
We suggest that such a patient be implanted with a cardioverter-defibrillator so that, to put it simply, "he does not die a second time". We know that the risk that the patient does notsurvivor of the second / next episode of cardiac arrest is very high.
On the other hand, there are many patients who have never had an episode of life-threatening ventricular arrhythmia and have never been resuscitated. However, we know that their underlying disease significantly increases (compared to the he althy population) the risk of life-threatening ventricular arrhythmias. These are, for example, patients with severe post-infarction heart damage, various cardiomyopathies, and genetically determined arrhythmogenic syndromes. These patients are offered the implantation of the device in the so-called primary prevention of sudden cardiac death.
It should be remembered that the risk of ventricular arrhythmia (and thus adequate device intervention) is significantly higher among patients with an implanted device in secondary prevention (compared to primary prevention) and that cardioverter-defibrillator works symptomatically, i.e. temporarily terminates life-threatening ventricular arrhythmias, and does not cure the underlying disease.
What does adequate or inadequate device intervention mean? Can I drive after ICD intervention?
If the intervention of the device was adequate, the device has operated correctly, that is, it has recognized and stopped VT and / or Fibrillation. The problem is not the device intervention itself, but the fact that a ventricular arrhythmia occurs. Rhythm disturbances are associated with the patient's underlying disease. Each intervention of the device requires urgent cardiological control in order to confirm the occurrence of life-threatening ventricular arrhythmias, possible extension of diagnostics and treatment of the causes of occurrence / intensification of cardiac arrhythmias. A three-month grace period in driving a motor vehicle after adequate cardioverter-defibrillator intervention is recommended.
If the device intervention was inadequate, i.e. not caused by ventricular arrhythmia, urgent cardiological control is also necessary. Its purpose is primarily to confirm the inadequacy of device therapy, to find the cause of such an intervention (e.g. atrial fibrillation with very fast ventricular action, defibrillation electrode failure, etc.), and to proceed to avoid similar interventions in the future (e.g. significantly slowing atrial fibrillation, responding to reprogramming the device, modifying pharmacotherapy, replacing the dysfunctional electrode with a new one, etc.)
In the event of inadequate intervention of the device, the patient may return to driving the car immediately after solving the problem of the cause of the inadequate therapiescardioverter-defibrillator (Table).
When after the implantation, device / electrode replacement, can you sit behind the wheel?
The implantation of a cardioverter-defibrillator is a procedure. There remains a wound that must heal. In the initial postoperative period, the edges of the wound may come apart, a hematoma may appear, the electrodes may become dislocated. It is recommended to wait a certain period of time before resuming normal activities (including driving) in order to ensure a proper healing process. It is described in detail in the aforementioned EHRA expert consensus.
For secondary prevention, it is recommended that you refrain from driving for about three months, for primary prevention and for one month of electrode replacement, and one week for device replacement. Of course, these are general recommendations and each patient should be approached individually. Detailed recommendations for patients are most often provided by the staff of the implantation center during check-up visits.
Do you need to wear seat belts?
Of course it is. Seat belts are obligatory - there is no exception to this rule. In the first period, when we recommend driving a car for one to three months (wound healing period), the patient will be driving on the passenger's side. The belt will then be on the right side, on the shoulder - it will not rub or otherwise interfere with the healing wound, which is most often on the left side. Later, after the wound has healed properly, the driver's side belt poses no threat to the implanted device and may save your life in the event of a mishap.
Expert
Author: Private Archive
Questions from ICD drivers are answered by dr hab. n. med. Michał Mazurek, expert of the Heart Rhythm Section of the Polish Society of Cardiology.