Guidelines set by the American Heart Association (AHA) and other medical organizations recommend patients treated for severe ventricular tachyarrhythmia wait at least six months before getting back behind the wheel. But more than half of those patients start driving again within three months, and their accident rate is lower than the average for all drivers, says a report in the Aug. 9 New England Journal of Medicine.
The findings are based on questionnaires filled out by 758 patients in a study that compared drug treatment with implantation of a defibrillator, a device that uses an electric jolt to restore normal heart rhythm. Fifty-seven percent of patients said they were driving again within three months; the percentage increased to 78 by six months and to 88 percent afer a year. And they had their share of problems: 2 percent reported a fainting episode, 11 percent had dizziness or palpitations that made them pull over, 22 percent had less severe dizziness that allowed them to keep driving, and 8 percent of those with defibrillators had at least one shock.The total number of accidents for the group was 55. Measured over 1,619 patient-years, that number translates to a rate of 3.4 percent per patient-year, "a lower frequency than the annual accident rate of 7.1 percent in the general driving population of the United States," the researchers say. It is also lower than the 4.9 percent annual rate for all drivers in the same age group and even lower than the accident rate reported by people in the study in the year before they had treatment.
It might be time for reconsideration of the AHA guidelines, says Dr. Frederick A. Ehlert, assistant professor of medicine at Columbia University College of Physicians and Surgeons and a member of the study team. But "I would want to explore that change with caution," he says.
Ehlert says he will continue to recommend a six-month wait for his patients. But he says his patients are in the New York area, where mass transit is readily available. In most other parts of the country, he says, "Restriction on driving has a major social impact on patients," so driving is "an absolute necessity" in everyday life.
"With all such recommendations, we have to weigh the dangers to individuals and to society against the rights of individuals," Ehlert says.
The study also showed that the highest rate of accidents after treatment involved patients who had accidents in the year before treatment. Ehlert says that shows that "if you are an accident-prone or bad driver before, you will be a bad driver after."
The study is valuable because it is the largest of its kind and includes both patients who had drug treatment and those who had defibrillators implanted, says Judy L. Powell, research nurse consultant at the University of Washington Clinical Trials Center,
"It is unique in that regard, with a large body of patients and those who had different treatments," she says.
The current guidelines about driving after treatment for an arrhythmia "should be revised as treatments for arrhythmia improve, and as more data become available," writes Dr. Timothy W. Smith of the Washington University School of Medicine in an accompanying editorial.
"The low risk associated with driving for the patients in the present study is comforting," Smith says. "Are these new data strong enough to change the recommendations for patients? Perhaps."
But Smith says he will stick to the present guidelines when his patients ask him for a recommendation. "On this matter, I am not yet ready to step off the curb," he says.
What To Do
"If a patient has an episode, I tell them to wait a period of time before driving," Ehlert says. "I arbitrarily choose six months, because a recurrence is most likely in a six-month period. If they are free of symptoms, I then allow them to resume driving."