Driving with an ICD

[Guest guest]

Do you drive with an ICD? My DH has one, has had since 2003. He had some shocks

(2) shortly after it was placed. Since then, nothing unless they start playing

with his meds. Then this past November, while vacationing in Arizona, he got

zapped twice. Actually passed out. They attributed (as best they can) to

dehydration. They also found he was over medicated with thyroid meds. His

doctors prefer he not drive. I surely don't want him passing out behind the

wheel, but what is the protocol? One doctor told him " never. " It had been 5

years since his last shock. His Mom was diabetic and drove, despite totaling

numerous cars while having insulin reactions. No one ever told her not to drive.

It's a scary thing, but problems can occur to anyone anywhere. He is having a

stress test on Tuesday to see if they are missing anything.

It's not a problem with me driving. We actually live in our 40 motorhome and I

drive it. . . always have, always will. Just wondered how others manage.

Dale

[Guest guest]

Hi, Dale -- I had an ICD implanted 2-1/2 years ago after one episode of passing out after a coughing fit, and having been diagnosed with cardiomyopathy, etc. a year earlier the ICD was recommended.

After the implantation, I was told to refrain from driving for 6 months. This was a significant burden, to not drive, and I started doing some research on the matter. And I did start to drive in a couple of months and drive a lot now. But I've never been shocked and am generally healthy and have had no episodes of syncope/fainting since.

There are two different areas of concern, one legal and one medical.

I'm sure it varies by state, but in my case, the state I officially live in (we travel full-time in a 5th wheel, so we're not in any one place very long) asks at driver's license renewal if you've had an episode of syncope (fainting for any reason, not just related to heart conditions) within past six months. If so, one needs a physician's clearance to drive. In this era of defensive medicine, I would expect that few physicians would stick their neck out for you on this. I couldn't find any state law about any requirement to report an episode of syncope or to stop driving if one happened. I only found reference to this in licensing procedures.

The "medical" issue relates to the research and data regarding ICD's and episodes of shocks while driving. There has been little study on this issue, and I believe most recommendations by physicians are based on limited actual information and are therefore very conservative and cautious. (Defensive medicine, for sure.) Of course, the situation varies form patient to patient, and you have to take into account that the general health status of people who have ICD's for one reason or another varies a great deal.

I found what is probably the best study out there which is summarized below. The facts seem to be that there is essentially no statistical increase in risk WHILE driving. Interestingly, there is a significant bump in incidents in the half-hour or so following a driving stint, but the actual number is still quite small..

Here is a brief, patient-friendly article from Bottom Line which summarizes this research:

(sorry - I can't seem to adjust the font size on this . . . )

The defibrillators that are implanted in people for instant correction of abnormal heartbeats pose no special risks for heart patients who drive, researchers report.

"What this confirms is what we already thought, that overall there is not a huge risk in this population," said study lead author Chris- tine M. Albert, MD, director of the Center for

Arrhythmia Prevention at Brigham and

Women's Hospital in Boston.

BACKGROUND

About 50,000 defibrillators are implanted

annually in the United States. Vice President Dick Cheney is one famous recipient of the device. There have been worries that the shock de- livered by the device to correct an abnormal heartbeat might be dangerous for drivers, Dr. Albert said.

THE STUDY

The study included 1,188 people with a

defibrillator, whose full name is implantable

cardioverter defibrillator (lCD). The patients were followed for an average of 562 days, during which time the devices delivered a total of 193 shocks within one hour of driving-a rate of-one shock for every 25,116 person-hours driving. None of the shocks resulted in an accident.

Overall, the study found that the incidence of having an ICD shock was not higher while a participant was driving. One oddity in the findings was that an ICD shock was twice as likely to be delivered during the 30 minutes

after someone drove a car, Dr. Albert said, an

indication of possible strains caused by driving.

"These data provide reassurance that

driving by ICD patients should not translate into an important rate of personal or public injury," according to the researchers.

EXPERT COMMENTARY

"This is very strong evidence that our

worries were not based on fact but were theoretical," said Bruce Wilkoff, MD, director of cardiac and tachyarrhythmia devices at the Cleveland Clinic.

But common sense factors into the safety issue of ICDs and drivers, Dr. Wilkoff added. "People who have frequent shocks tend not to drive in the first place." Twenty percent of the ICD recipients in the study did not drive at all, Dr. Wilkoff noted.

DRIVING RECOMMENDATIONS

Current guidelines say that someone who is given an ICD after experiencing a major

arrhythmia - an irregular heartbeat - should not drive for at least one week after the implant. The one-week restriction also applies for

patients who have not experienced an arrhythmia to allow for recovery from the surgery. Driving restrictions then should be decided during

consultation with a physician, Dr. Albert said.

In practice, that works out to "don't drive when you're not feeling well," Dr. Wilkoff said.

I think this "pop" version of this study is a bit too simplistic, but informative. I am attaching the actual article reporting the study from the Journal of American Cardiology, published in 2007:

Driving and Implantable Cardioverter-Defibrillator Shocks for Ventricular Arrhythmias: Results From the Triggers of Ventricular Arrhythmia Study

The entire article is quite technical and presented in "research-ese" but if you wade through it you will find that, though this is a limited study, it was well done, and among other details, note that 80% of folks with ICD's drive at least once a week, including 75% of those with recent implantation. Those who drove the most tended, as you might guess, to be younger, generally healthier, etc.

The entire article is attached as a Word document. If this doesn't come through and you want to see it, let me know here and I will email it directly to you.

Bill on

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In a message dated 5/15/2010 5:58:03 P.M. Eastern Daylight Time, dapace31@... writes:

Do you drive with an ICD? My DH has one, has had since 2003. He had some shocks (2) shortly after it was placed. Since then, nothing unless they start playing with his meds. Then this past November, while vacationing in Arizona, he got zapped twice. Actually passed out. They attributed (as best they can) to dehydration. They also found he was over medicated with thyroid meds. His doctors prefer he not drive. I surely don't want him passing out behind the wheel, but what is the protocol? One doctor told him "never." It had been 5 years since his last shock. His Mom was diabetic and drove, despite totaling numerous cars while having insulin reactions. No one ever told her not to drive.It's a scary thing, but problems can occur to anyone anywhere. He is having a stress test on Tuesday to see if they are missing anything.It's not a problem with me driving. We actually live in our 40 motorhome and I drive it. . . always have, always will. Just wondered how others manage.Dale