Incidence of ventricular arrhythmias after implantable cardioverter-defibrillator implantation or replacement, and driving restriction consequences - 22/11/24

Doi : 10.1016/j.acvd.2024.10.005

Thomas Marc ^a, Karim Benali ^a,^b, Pierre Groussin ^a, Redwane Rakza ^a, Joana Brito ^a, Nathalie Behar ^a, Philippe Mabo ^a, Dominique Pavin ^a, Christophe Leclercq ^a, Vincent Galand ^a, Raphaël P. Martins ^a,⁎
^a Inserm, LTSI – UMR 1099, CHU de Rennes, Rennes University, 35000 Rennes, France
^b CHU de Saint-Étienne, 42000 Saint-Étienne, France

^⁎Corresponding author: Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.Service de cardiologie et maladies vasculaires, CHU de Rennes2, rue Henri-Le-GuillouxRennes35000France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 22 November 2024

Graphical abstract

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Highlights

•	We assessed VA incidence after ICD implantation/replacement.
•	The risk of VAs during the month after primary prevention is negligible.
•	For patients in primary prevention, a shorter driving restriction could be proposed.
•	More than 10% of secondary prevention patients have VAs during the first 3 months.
•	This supports current guidelines on driving restriction in secondary prevention.
•	The risk of VA during the week following device replacement was negligible.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Following implantation/replacement of an implantable cardioverter-defibrillator, patients are legally subjected to variable lengths of driving restrictions based on the indication (1 and 3 months after primary and secondary prevention, respectively; 1 week after device replacement).

Aim

To assess the incidence of ventricular arrhythmia during the theoretical driving restriction period in a large cohort of patients.

Methods

Patients who underwent implantable cardioverter-defibrillator implantation for primary or secondary prevention or device replacement between 2015 and 2021 were included retrospectively. The primary endpoint was the occurrence of ventricular arrhythmia during the theoretical driving restriction period, as defined by guidelines.

Results

A total of 914 patients were analysed, including 654 first implantations (438 and 216 for primary and secondary prevention, respectively) and 260 device replacements. The primary outcome occurred in 2/438 patients (0.004%) during the 1-month period following device implantation for primary prevention and in 25/216 patients (11.5%) during the 3-month period following device implantation for secondary prevention; it did not occur in the 1-week period following device replacement. The monthly calculated risk of harm remained below the accepted threshold of 0.005% for each group.

Conclusions

Primary prevention patients, such as those who have undergone device replacement, have a low risk of ventricular arrhythmia, which could lead to a reduction in their driving restriction period. Secondary prevention patients experienced a higher risk of recurrent ventricular arrhythmia, supporting the 3-month driving restriction period.

Le texte complet de cet article est disponible en PDF.

Keywords : Implantable cardioverter-defibrillator, Driving, Driving restriction, Arrhythmias

Plan

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