title: The implantable defibrillator and return to operation of vehicles study.
abstract: OBJECTIVE
  We sought to characterise driving habits of contemporary implantable cardioverter defibrillator (ICD) patients.
  
  
  RESULTS
  We performed a multicentre prospective observational study of consecutive ICD recipients. Non-commercial drivers with a valid licence were eligible. Patient and ICD data were recorded. All patients completed an anonymous questionnaire regarding their driving habits. Among 275 patients, 25 (9.1%) stopped driving permanently after ICD implantation. During a mean follow-up of 26.5 ± 4.5 months, 25.3% of patients received an ICD shock (52.5% appropriate). The median time to first shock was 7.0 (2.5, 17.5) months and was not significantly different between primary and secondary ICD patients. However, shocks (36.5 vs. 21.3%, P = 0.027) and recurrent shock episodes (17.5 vs. 6.2%, P = 0.011) were more common in secondary ICD patients. Physician-recommended driving restrictions were not recalled by 37.9% and not followed by 23.0% of patients. Overall, the mean duration of driving abstinence was 2.2 ± 2.9 and 3.6 ± 5.3 months for primary and secondary patients, respectively. Notably, 36.5% of secondary patients drove within 1 month. Eight patients (3.3%) received a shock while driving, five of which resulted in road traffic accidents. The annual risk of a shock while driving was 1.5%.
  
  
  CONCLUSIONS
  Patient driving behaviour following ICD implantation is variable, with over one-third not remembering and almost one-quarter not adhering to physician-directed driving restrictions. Over one-third of secondary ICD patients drive within 1 month despite physician recommendations. Further studies are required to establish the optimal duration of driving restriction in ICD recipients.
authors.affiliation: Department of Clinical Cardiology, University College Hospital Galway, Galway, Republic of Ireland. darrenmylotte@gmail.com
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Richard G
authors.initials: RG
authors.lastname: Sheahan
authors.forename: Paul G
authors.initials: PG
authors.lastname: Nolan
authors.forename: Mary Antoinette
authors.initials: MA
authors.lastname: Neylon
authors.forename: Brian
authors.initials: B
authors.lastname: McArdle
authors.forename: Orla
authors.initials: O
authors.lastname: Constant
authors.forename: Audrey
authors.initials: A
authors.lastname: Diffley
authors.forename: David
authors.initials: D
authors.lastname: Keane
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Nash
authors.forename: James
authors.initials: J
authors.lastname: Crowley
authors.forename: Kieran
authors.initials: K
authors.lastname: Daly
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D001334:Automobile Driving / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors