Driving under the influence o... Health Article
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New guidelines refine how long to wait after getting an ICD.
If you have an implantable cardioverter-defibrillator (ICD), your doctor probably told you to wait six months after getting it before driving. That advice comes from recommendations made back in 1996 by the American Heart Association (AHA) and what is now called the Heart Rhythm Society (HRS). At that time, most people who got an ICD did so only after blacking out or suffering a cardiac arrest due to a potentially deadly heart rhythm.
A growing number of people who have never had a heart rhythm problem, mainly heart attack survivors, are getting ICDs to prevent just such an occurrence. Should they wait six months before driving, too? Not necessarily, say the two organizations.
Preventive ICDs
An ICD is about half the size of a deck of cards. It is implanted under the skin below the collarbone. One or more long thin wires, called leads, connect it to the heart.
ICDs were initially used to treat life-threatening abnormal heart rhythms (arrhythmias) such as ventricular fibrillation, which makes the heart's lower muscular chambers (the ventricles) quiver without actually squeezing and pumping. When the device senses an abnormal heart rhythm, it can administer a brief, intense electrical shock to the heart that aborts the abnormal rhythm and restarts a normal one. Many people say the shock feels like being punched in the chest. It can be surprising enough, or painful enough, to make you lose control of a car.
Modern ICDs can also generate milder electrical impulses that regulate or "pace" the heartbeat if other types of arrhythmia appear.
A landmark trial published in 2002 showed that heart attack survivors who received ICDs and excellent medical care survived longer than those who received "only" excellent medical care. Since then, a growing number of heart attack survivors who have never experienced an arrhythmia are getting ICDs.
Driving sooner
For people who have survived a potentially lethal arrhythmia, it makes sense to wait for six months or so before driving. That's usually enough time to see if the heart rhythm problem persists and if the device is controlling it. For heart attack survivors who get an ICD purely to prevent a future heart rhythm problem, the AHA and HRS shortened the no-driving period to one week. The latest recommendations were published in the March 2, 2007 Circulation.
The organizations made this change because only about one in a dozen people who get an ICD as a preventive measure gets a shock from it over the course of a year. Factor in the small amount of time that most people spend driving, and the odds in this group of losing control of a car because of symptoms from a rhythm problem or the firing of the ICD are tiny.
As long as the ICD hasn't fired and there aren't any symptoms such as fainting or shortness of breath related to a heart rhythm problem, you can drive as you did before getting the device. If either of these happen, you need to stop driving for six months.
Keep in mind, though, that the chances of losing consciousness — and control of the car — aren't zero. In a study of almost 600 people who survived a near-fatal heart rhythm problem, 8% of those who had received an ICD reported getting a shock while driving.
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Driving with a heart rhythm disorder Some heart rhythm problems don't warrant any driving restrictions. Others do. Here's a rundown. |
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Type of rhythm disorder |
Driving restriction |
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ICD implantation following cardiac arrest or other serious arrhythmia |
Wait six months after implantation. After a shock or symptoms, wait six months. |
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ICD implantation following a heart attack without previous heart rhythm problems |
Wait at least one week after implantation. No restrictions after that as long as there are no symptoms and the ICD does not fire. After a shock or symptoms, wait six months. |
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Ventricular rhythm problems |
Wait three to six months, depending on the presence of symptoms. No driving if the problem is not under control. |
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Atrial fibrillation and other supraventricular arrhythmias |
No restrictions if there are no symptoms or they are under control. No driving if the problem is not under control. |
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Slow heartbeat |
No restrictions if there are no symptoms or they are completely under control. No driving if the problem causes symptoms. If a pacemaker is placed to correct the problem, wait one week after placement before resuming driving. |
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Fainting and near-fainting |
Depends on the cause and severity of the problem. |
Let caution be your guide
Who can drive, and who should not, pits an individual's rights against the needs of society. For people who don't live near good public transportation, driving is the only way they can shop for food, see family and friends, or get to work. At the same time, the citizens of a society have the right to try to protect themselves against the harm that could be caused by individuals who can't safely drive a car.
Given the possibility that you can hurt others, not just yourself, be a good citizen — err on the side of caution when it comes to driving off with a heart rhythm problem.