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Jun 14, 2011

Driving Restriction Guidelines for Patients with Implantable Cardioverter Defibrillators

Find out which patients with ICDs shouldn’t drive within 2-4 months of their last shock.

An implantable cardioverter defibrillator (ICD) is a small device placed in the chest or abdomen of patients with an irregular heartbeat or history of sudden cardiac arrest.  These devices send electrical pulses or shocks to the heart when they sense any abnormalities in heartbeat. For example, if a patient with an ICD has an irregular heartbeat or goes into sudden cardiac arrest, the device will send a shock to the heart to restore normal heart rhythm. ICDs can be life-saving, as cardiac arrest can cause death within minutes if not treated.

However, with an increase in ICD implants over the years, doctors worry about the risk these devices may impose on patients while driving a vehicle. When an ICD sends an electrical pulse to the heart, it can cause sudden pain and incapacitate patients. If this shock were to happen while a patient was operating a vehicle, it could cause serious harm to the driver and others around him. So should patients with ICDs be permitted to drive at all?

A recent study helped quantify the risk associated with ICD patients driving, in order to help provide concrete guidelines surrounding this issue. Researchers found that directly after implantation of an ICD, patients with private driving habits are at low-risk for shock and should therefore be permitted to drive. This also holds true for patients with an ICD following an inappropriate shock, which occurs when an ICD mistakenly shocks the heart. However, risk of harm while driving increases in patients with a recent appropriate shock, when the electrical shock was necessary to restore the heart’s rhythm. Following an appropriate shock, patients should be restricted from driving for 2 months, and those with a history of sudden cardiac arrest should not drive for 4 months.

It is important to note that these guidelines apply only to patients that drive for personal use, rather than professional use. Those with professional driving habits, such as truck drivers, should not be allowed to drive for this purpose after receiving an ICD implant, as risk is substantially higher than those with private driving habits. 

Questions for You to Consider

  • What is the difference between an ICD and a pacemaker?
  • The biggest difference between an ICD and pacemaker is that an ICD continually monitors heart rhythm and can send low- or high-energy electrical pulses to correct an abnormal heart rhythm. ICDs will initially send low-energy pulses to restore heart rhythm but switch to high-energy pulses when the low-energy shocks are ineffective. Pacemakers, however, only give low-energy electrical pulses to restore regular heartbeat. Therefore, ICDs are more effective in patients at high-risk for or history of sudden cardiac arrest, who may need these more powerful, high-energy electrical pulses to restore their regular heartbeat.
  • How did researchers determine the risk associated with ICD implants and driving?

  • A total of 2,786 ICD patients were followed for an average of nearly 3 years following implantation. During this time, researchers tracked the occurrence of shocks from the ICD. A risk of harm formula was then used to calculate the risk for shock from the time of implantation, and therefore risk of harm while driving.

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Resources to Help You Compare Treatment Options

Guidance from the Agency for Healthcare Research and Quality (AHRQ) in making health decisions