title: Driving restrictions after implantable cardioverter defibrillator implantation: an evidence-based approach.
abstract: OBJECTIVE
  Little evidence is available regarding restrictions from driving following implantable cardioverter defibrillator (ICD) implantation or following first appropriate or inappropriate shock. The purpose of the current analysis was to provide evidence for driving restrictions based on real-world incidences of shocks (appropriate and inappropriate).
  
  
  RESULTS
  A total of 2786 primary and secondary prevention ICD patients were included. The occurrence of shocks was noted during a median follow-up of 996 days (inter-quartile range, 428-1833 days). With the risk of harm (RH) formula, using the incidence of sudden cardiac incapacitation, the annual RH to others posed by a driver with an ICD was calculated. Based on Canadian data, the annual RH to others of 5 in 100 000 (0.005%) was used as a cut-off value. In both primary and secondary prevention ICD patients with private driving habits, no restrictions to drive directly following implantation, or an inappropriate shock are warranted. However, following an appropriate shock, these patients are at an increased risk to cause harm to other road users and therefore should be restricted to drive for a period of 2 and 4 months, respectively. In addition, all ICD patients with professional driving habits have a substantial elevated risk to cause harm to other road users during the complete follow-up after both implantation and shock and should therefore be restricted to drive permanently.
  
  
  CONCLUSIONS
  The current analysis provides a clinically applicable tool for guideline committees to establish evidence-based driving restrictions.
authors.affiliation: Department of Cardiology,  Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Thijssen
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Rees
authors.forename: Mihály K
authors.initials: MK
authors.lastname: de Bie
authors.forename: Enno T
authors.initials: ET
authors.lastname: van der Velde
authors.forename: Lieselot
authors.initials: L
authors.lastname: van Erven
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Cannegieter
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009784:Occupational Diseases / Q000517:prevention & control; D011322:Primary Prevention / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data; D013997:Time Factors