Driving and Arrhythmias: Implications of New Data
Tóm tắt
Patients with ventricular arrhythmias are often restricted from driving by their physicians for several months. These recommendations are based more on convention than evidence, due to the paucity of data previously available on the safety of driving in these patients. Over the past few years, however, more data have become available that suggests that it is safe to drive within three months of their ventricular tachyarrhythmia. In this paper, we look at this more recent data and make the suggestion that patients with well maintained cardiac function, no recurrent ventricular arrhythmias (i.e. electrical storm) and no persistent medical condition predisposing them to ventricular arrhythmias should be allowed to resume driving soon after their ventricular tachyarrhythmia.
Tài liệu tham khảo
Akiyama T, Powell JL, Mitchell LB, Ehlert FA, Baessler C. Resumption of driving after life-threatening ventricular tachyarrhythmia. N Eng J Med 2001; 345: 391-397.
The Antiarrhythmiacs versus Implantable Defibrillators (AVID) Investigators. A comparison of anti-arrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Eng J Med 1997; 337: 1576-1583.
Smith TW. Driving after ventricular arrhythmias. N Eng J Med 2001; 345: 451-452.
Traffic Safety Facts 1997. Washington, D.C.: National Highway Traffic Safety Administration, 1998: 98. (Accessed July 18, 2001, at http://www.nhtsa.dot.gov/people/ ncsa/pdf/TSF97.pdf.).
Hansotia P, Broste SK. The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. N Eng J Med 1991; 324: 22-26.
Waller JA. Chronic medical conditions and traffic safety: Revies of the California experience. N Engl J Med 1965; 273: 1413-1420.
Dhala A, Bremner S, Blanck Z, Sra J, Deshpande S, Jazayeri MR, Akhtar M. Impairment of driving abilities in patients with supraventricular tachycardias. AmJ Cardiol 1995; 75: 516-518.
Strickberger SA, Cantillon CO, Friedman PL. Whenshould patients with lethal ventricular arrhythmias resume driving? An analysis of state regulations and physician practices. Ann Intern Med 1991; 115: 560-563.
Dicarlo LA, Winston SA, Honoway S, Reed P. Driving restrictions advised by midwestern cardiologists implanting cardioverter defibrillators: Present practices criteria utilized, and compatibility with existing state laws. Pacing Clin Electrophysiol 1992; 15: 1131-1136.
Curtis AB, Conti JB, Tucker KJ, Kubulis PS, Reilly RE, Woodward DA. Motor vehicle accidents in patients with an implantable cardioverter-defibrillator. J Am Coll Cardiol 1995; 26: 180-184.
Assessment of the cardiac patient for fitness to drive: 1996 update. Can J Cardiol 1996; 12: 1164-1170, 1175-1182.
Jung W, Anderson M, Camm AJ, Jordaens L, Petch MC, Rosenqvist M, Santini M, Luderitz B. Recommendations for driving of patients with implantable cardioverter de-fibrillators. Eur Heart J 1997; 18: 1210-1219.
Epstein AE, Miles WM, Benditt DG, Camm AJ, Darling EJ, Friedman PL, Garson A, Harvey JC, Kidwell GA, Klein GJ, Levine PA, Marchlinski FE, Prystowsky EN, Wilkoff BL. Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations. Circulation 1996; 94: 1147-1166.
Trappe HJ, Wenzlaff P, Grellman G. Should patients with implantable cardioverter-defibrillators be allowed to drive? Observations in 291 patients from a single center over an 11-year period. J Interventional Cardiac Electrophysiol 1998; 2: 193-201.
Kim SG, Hallstrom A, Love JC, Rosenberg Y, Powell J, Roth J, Brodsky M, Moore R, Wilkoff B. Comparison of clinical characteristics and frequency of implantable defibrillator use between randomized patients in the antiarrythmics vs implantable defibrillator (AVID) trial and nonrandomized registry patients. Am J Cardiol 1997; 80: 454-457.
Exner DV, Pinski SL, Wyse G, Renfroe EG, Follman D, Gold M, Beckman KJ, Coromilas J, Lancaster S, Hallstrom AP. Electrical storm presages nonsudden death; the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation 2001; 103: 2066-2071.