For Week After Receiving ICD, Getting Behind Wheel Seen Risky

DALLAS, Feb. 9 -- Patients who receive an implantable cardioverter defibrillators (ICD) for primary prevention should take a least a week before driving.

So said the American Heart Association/Heart Rhythm Society in a scientific statement that updated a decade-old advisory about safety risks after ICD implantation -- specifically loss of consciousness -- that would affect driving or flying a plane.

The updated statement, which was published in an online edition of Circulation, Journal of the American Heart Association said driving can be resumed a week after implant if patients remain asymptomatic.

The original statement addressed devices that were implanted in patients who devices implanted following a life-threatening arrhythmia.

Those patients should refrain from driving for at least six months, the AHA/HRS said in the 1996 joint statement.

The latest statement recommends that six-month driving restriction for patients who "received an ICD for primary prevention who subsequently receive an appropriate therapy for ventricular tachycardia or ventricular fibrillation."

But many patients who have received ICDs will never experience "appropriate therapy," i.e. a shock for ventricular fibrillation or ventricular tachycardia.

One such example is Dick Cheney, the vice president. His cardiologists have consistently reported that Cheney's ICD, which was implanted following a myocardial infarction in November 2000, has never delivered "appropriate therapy."

The new statement also recommends that physicians instruct patients who receive ICDs for primary prevention "that impairment of consciousness is a possible future event."

The AHA/HRS "recommendations do not apply to the licensing of commercial drivers." Patients with ICDs, irrespective of primary or secondary prevention indication, cannot be certified as commercial drivers according to the U.S. Department of Transportation guidelines.

The use of ICDs for primary prevention surged after results of a series of major trials-Multicenter Automatic Defibrillator Implantation Trials I and II (MADIT I, II), Multicenter UnSustained Tachycardia Trial (MUSTT), Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), and the Sudden Cardiac Death in Heart Failure (SCD-HeFT)-all reported a survival advantage for high risk patients who received ICDs.

The remaining 10 members reported financial support from one or more of these companies Guidant, St. Jude, Medtronic, ProRhythm, Bristol-Myers Squibb, Wyeth, Cardiome, Cryocath, and Biovail.