Resumption of Driving after Life-Threatening Ventricular Tachyarrhythmia
Toshio Akiyama, M.D., Judy L. Powell, B.S.N., L. Brent Mitchell, M.D., Frederick A. Ehlert, M.D., Christina Baessler, M.S.N., for the Antiarrhythmics versus Implantable Defibrillators Investigators
Background Although the privilege of driving must be respected,it may be necessary to restrict driving when it poses a threatto others. The risks associated with allowing patients withlife-threatening ventricular tachyarrhythmias to drive havenot been quantified.
Methods The Antiarrhythmics versus Implantable Defibrillators(AVID) trial compared antiarrhythmic-drug therapy with the implantationof defibrillators in patients resuscitated from near-fatal ventriculararrhythmias. In the current study, we sent patients who participatedin the AVID trial a questionnaire, to be completed anonymously,requesting information about driving habits and experiences.
Results The questionnaire was returned by 758 of 909 patients(83 percent). Of these, 627 patients drove during the year beforetheir index episode of ventricular tachyarrhythmia. A totalof 57 percent of these patients resumed driving within 3 monthsafter randomization in the AVID trial, 78 percent within 6 months,and 88 percent within 12 months. While driving, 2 percent hada syncopal episode, 11 percent had dizziness or palpitationsthat necessitated stopping the vehicle, 22 percent had dizzinessor palpitations that did not necessitate stopping the vehicle,and 8 percent of the 295 patients with an implantable cardioverter–defibrillatorreceived a shock. Fifty patients reported having at least 1accident, for a total of 55 accidents during 1619 patient-yearsof follow-up after the resumption of driving (3.4 percent perpatient-year). Only 11 percent of these accidents were precededby symptoms of possible arrhythmia (0.4 percent per patient-year).
Conclusions Most patients with ventricular tachyarrhythmiasresume driving early. Although it is common for them to havesymptoms of possible arrhythmia while driving, accidents areuncommon and occur with a frequency that is lower than the annualaccident rate of 7.1 percent in the general driving populationof the United States.
Source Information
From the University of Rochester Medical Center, Rochester, N.Y. (T.A.); the University of Washington, Seattle (J.L.P.); the University of Calgary, Calgary, Alta., Canada (L.B.M.); St. Luke's–Roosevelt Hospital Center, New York (F.A.E.); and the Medical College of Pennsylvania–Hahnemann University, Philadelphia (C.B.).
Address reprint requests to Ms. Powell at the AVID Clinical Trial Center, University of Washington, 1107 N.E. 45th St., Rm. 505, Seattle, WA 98105-4689, or at avidctc{at}u.washington.edu.
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