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This Article Figures Only Full Text Full Text (PDF) View TOVA investigators View TALK BACK Discussion All Versions of this Article: j.jacc.2007.06.059v1 50/23/2233    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Albert, C. M. Search for Related Content PubMed Articles by Albert, C. M. Related Collections Related Article

CLINICAL RESEARCH: HEART RHYTHM DISORDER

Driving and Implantable Cardioverter-Defibrillator Shocks for Ventricular Arrhythmias

Results From the TOVA Study

Christine M. Albert, MD, MPH^_*,_*, Lawrence Rosenthal, MD, Hugh Calkins, MD, Jonathan S. Steinberg, MD, Jeremy N. Ruskin, MD^||, Paul Wang, MD, MPH^¶, James E. Muller, MD, MPH^||, Murray A. Mittleman, MD, MPH^# for the TOVA Investigators

^_* Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
Cardiovascular Division, University of Massachusetts Memorial Center Hospital, Worcester, Massachusetts
Cardiovascular Division, Johns Hopkins Hospital, Baltimore, Maryland
Cardiovascular Division, St. Luke’s-Roosevelt Hospital Center and Columbia University, New York, New York
^|| Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
^¶ Cardiovascular Division, Stanford University Medical Center, Stanford, California
^# Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Manuscript received May 9, 2007; accepted June 13, 2007.

^_* Reprint requests and correspondence: Dr. Christine M. Albert, Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Division, Brigham and Women’s Hospital, 900 Commonwealth Avenue East, Boston, Massachusetts 02215-1204. (Email: calbert{at}partners.org).

Objectives: This study examined the risk of implantable cardioverter-defibrillator (ICD) shocks for ventricular tachycardia (VT) or ventricular fibrillation (VF) associated with driving.

Background: Concerns regarding VT/VF occurring during driving are the basis for driving restrictions in ICD patients; however, limited data are available to inform recommendations.

Methods: This study used a prospective nested case-crossover design to compare the risk of ICD shock for VT/VF both during and up to 60 min after an episode of driving as compared with that during other activities among 1,188 ICD patients enrolled in the TOVA (Triggers of Ventricular Arrhythmia) study.

Results: Over a median follow-up of 562 days, there were 193 ICD shocks for VT/VF with data on exposure to driving before ICD shock. The absolute risk of ICD shock for VT/VF within 1 h of driving was estimated to be 1 episode per 25,116 person-hours spent driving. The ICD shocks for VT/VF were twice as likely to occur within 1 h of driving a car as compared with other times (relative risk [RR] 2.24, 95% confidence interval [CI] 1.57 to 3.18). This risk was specific for shocks for VT/VF and occurred primarily during the 30-min period after driving (RR 4.46, 95% CI 2.92 to 6.82) rather than during the driving episode itself (RR 1.05, 95% CI 0.48 to 2.30).

Conclusions: Although the risk of ICD shock for VT/VF was transiently increased in the 30-min period after driving, the risk was not elevated during driving and the absolute risk was low. These data provide reassurance that driving by ICD patients should not translate into an important rate of personal or public injury.

Abbreviations and Acronyms   CI = confidence interval   ICD = implantable cardioverter-defibrillator   MET = metabolic equivalent   MI = myocardial infarction   RR = relative risk   VF = ventricular fibrillation   VT = ventricular tachycardia

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