title: Recurrent cardiac events in survivors of ventricular fibrillation or tachycardia. Implications for driving restrictions.
abstract: OBJECTIVE
  To determine when survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) might most safely return to driving.
  
  
  METHODS
  Consecutive case series of 501 VT and VF survivors discharged alive between August 1978 and October 1989 and followed from 0 to 117 months (mean, 26 months).
  
  
  METHODS
  Cardiac arrhythmia service of a university hospital.
  
  
  METHODS
  The study group comprised 290 consecutive patients with sustained VT and 211 patients with VF who underwent electrophysiological studies and were discharged alive (78% male; mean age, 59 years). The mean ejection fraction (available in 338 patients) was 0.42.
  
  
  METHODS
  Antiarrhythmic drug testing for all patients was guided by serial electrophysiological testing. Overall, 227 patients (45%) were discharged on conventional antiarrhythmic agents, 115 (23%) on amiodarone, 39 (8%) received an implantable defibrillator, and 120 (24%) received no specific antiarrhythmic therapy.
  
  
  METHODS
  Main outcomes included any event that could hamper a patient's ability to operate a motor vehicle. Specifically, these events included recurrent VF, poorly tolerated, hemodynamically unstable VT, syncope, sudden cardiac death, and implantable defibrillator discharge.
  
  
  RESULTS
  Event risks were assessed during the first year after hospital discharge because that is when most patients decide whether to begin driving again. The 1-year outcome event rate for all 501 patients was 17%. Three distinct periods of risk were identified. The monthly hazard rate was highest in the first month after hospital discharge (4.22% per month), intermediate in months 2 through 7 (1.81% per month), and lowest in months 8 through 12 (0.63% per month). The 191 patients for whom no successful conventional antiarrhythmic drug could be found during electrophysiological testing experienced a persistently high monthly event risk (1.6%) during months 8 through 12.
  
  
  CONCLUSIONS
  All survivors of VT or VF should refrain from driving during the first month after hospital discharge when the hazard for events that could impair their ability to drive is greatest. Our data would support restricting driving for most patients until the eighth month after hospital discharge, when risk becomes lowest. Restriction might be lengthened in patients for whom electrophysiological testing finds no satisfactory conventional antiarrhythmic agent because their risk remains higher than average even after 7 months. Individualized recommendations should be allowed because the accident rate for patients who actually suffer sudden death is low.
authors.affiliation: Cardiology Section, Portland Veterans Affairs Medical Center, OR 97201.
authors.forename: G C
authors.initials: GC
authors.lastname: Larsen
authors.forename: M R
authors.initials: MR
authors.lastname: Stupey
authors.forename: C G
authors.initials: CG
authors.lastname: Walance
authors.forename: K K
authors.initials: KK
authors.lastname: Griffith
authors.forename: J E
authors.initials: JE
authors.lastname: Cutler
authors.forename: J
authors.initials: J
authors.lastname: Kron
authors.forename: J H
authors.initials: JH
authors.lastname: McAnulty
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001334:Automobile Driving; D017147:Defibrillators, Implantable; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012306:Risk; D013610:Tachycardia / Q000503:physiopathology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy