Driving restrictions in patients with implantable cardioverter defibrillators and pacemakers

Figures

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  Fig. 1. Incidence rate of syncope associated with appropriate ICD therapies in secondary prevention patients. Literature reported incidence rates of syncope associated with appropriate ICD shock deliveries are presented in a chronological order. These earlier studies primarily included more secondary prevention patients. The mean value of the seven studies (Kou [4], Bansch [5], Trappe [6], Freedberg [7], Klein [8], Lerecouvreux [56], and the Japanese survey for appropriate ICD therapies (Japanese ICD survey 2)) was 11.2%. In the Japanese ICD survey 2, the appropriate ICD therapy event data between 1997 and 2014 from 58 Japanese institutions were analyzed retrospectively (unpublished data). In brief, 1415 appropriate ICD therapies (ATP, cardioversion, and defibrillation for VT/VF) occurring in 886 patients (age 65±14 years, secondary prevention 63%) were analyzed. For the second therapy analysis, only a subsequent inappropriate therapy occurring >24 h after the first inappropriate shock was considered a second therapy. A total of 532 (60%) experienced a second appropriate therapy during a follow-up period of 3.6 years. ICD: implantable cardioverter-defibrillator, ATP: antitachycardia…

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  Fig. 2. Annual risk of harm from appropriate ICD therapies in a Japanese survey. The annual risk of harm in ICD patients based on the cumulative incidence of appropriate ICD therapies is illustrated. In the Japanese survey for appropriate ICD therapies (Japanese ICD survey 2), the annual RH to others was lower than 5 in 100,000 at 3 months after the first shock. The syncope rates of 32% and 14% were reproduced from Merchant et al. [36].

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  Fig. 3. Incidence rate of syncope associated with appropriate ICD therapies in primary prevention patients. Literature has reported the incidence rate of syncope associated with appropriate ICD shock deliveries sorted in a chronological order. These studies aimed to examine the effect of strategic programming mainly for primary prevention patients. The mean value of the ten studies (Pain Free I [57], Pain Free II [58], Comparison of Empiric to Physician-Tailored Programming of ICDs (EMPIRIC) [59], Primary Prevention Parameters Evaluation (PREPARE) [28], PITAGORA [60], Role of Long Detection Window Programming in Patients With Left Ventricular Dysfunction, Non-ischemic Etiology in Primary Prevention Treated with a Biventricular ICD (RELEVANT) [29], Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III (ADVANCE III) [61], Buber [9], Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy (MADIT-RIT) [30], and Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock (PROVIDE) [31]) was 1.6%.

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  Fig. 4. Age distribution of the ICD recipients and motor vehicle accidents in Japan. The age of the ICD recipients in our ICD survey 2 and motor vehicle accidents in Japan in 2014 are shown. The number of ICD recipients increases in proportion to an advancing age, but the rate of motor vehicle accidents has relatively decreased in the population of more than 70 years old.