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Europace Advance Access published online on June 13, 2009
Europace, doi:10.1093/europace/eup112
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

CONSENSUS STATEMENT

Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators

Task force members, Johan Vijgen, (chairman)1,*, Gianluca Botto2, John Camm3, Carl-Johan Hoijer4, Werner Jung5, Jean-Yves Le Heuzey6, Andrzej Lubinski7, Tone M. Norekvål8 {dagger}, Maurizio Santomauro9, Martin Schalij10, Jean-Paul Schmid11 {ddagger} and Panos Vardas12

1 Department of Cardiology, Virga Jesse Ziekenhuis, Hasselt, Belgium; 2 Department of Cardiology, St. Anna Hospital, Como, Italy; 3 Department of Cardiac and Vascular Sciences, St. George's University, London, United Kingdom; 4 Department of Cardiology, Lund University Hospital, Lund, Sweden; 5 Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany; 6 Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France; 7 Department of Interventional Cardiology, Medical University of Lodz, Poland; 8 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; 9 Department of Cardiology, Federico II University Naples, Naples, Italy; 10 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 11 Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland; 12 Department of Cardiology, Heraklion University Hospital, Heraklion Crete, Greece

Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document.
Restriction for private driving Restriction for professional driving
ICD implantation for secondary prevention Three months Permanent
ICD implantation for primary prevention Four weeks Permanent
After appropriate ICD therapy Three months Permanent
After inappropriate ICD therapy Until measures to prevent inappropriate therapy are taken Permanent
After replacement of the ICD One week Permanent
After replacement of the lead system Four weeks Permanent
Patients refusing ICD for primary prevention No restriction Permanent
Patients refusing ICD implantation for secondary prevention Seven months Permanent

Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.

* Corresponding author: Tel: +32 11 307 842, Fax: +32 11 307 839, Email: johan.vijgen{at}virgajesse.be

{dagger} Past Chair, Council on Cardiovascular Nursing and Allied Professions in ESC (CCNAP).

{ddagger} Nucleus Member of the Section Cardiac Rehabilitation of the European Association of Cardiovascular Prevention and Rehabilitation.


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