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J Am Coll Cardiol, 2008; 52:317, doi:10.1016/j.jacc.2008.03.053
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

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Christine M. Albert, MD, MPH* and Murray A. Mittleman, MD, MPH

* Brigham and Women's Hospital Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Division, 900 Commonwealth Avenue East, Boston, Massachusetts 02215 (Email: calbert{at}partners.org).

We thank Dr. Falk for his interest in our study (1) and for directing us to these earlier published data on the association between driving and ventricular arrhythmias. As Dr. Falk points out, the majority of the arrhythmias in the prior studies seemed to be stress-induced (2–4), and most occurred in patients with active ischemia (4). Although the majority of implantable cardioverter-defibrillator (ICD) patients in the TOVA (Triggers Of Ventricular Arrhythmias) study population had a history of coronary artery disease (n = 802; 73.6%), only 12% of participants reported experiencing any angina at baseline. Therefore, as Dr. Falk surmised, the number of patients with active ischemia in this ICD population is quite low. Therefore, it is potentially possible that a higher rate of ventricular arrhythmias might be observed in patients with active ischemia. Unfortunately, the small number of patients with active ischemia in our study limited our ability to perform this important subgroup analysis. It is also of interest that the majority of the rhythm disturbances in these earlier studies occurred during the driving episode (2–4) itself as opposed to those in our study, which occurred after (1), suggesting that intermediary mechanisms, such as exposure to air pollution, might play a greater role in the precipitation of ventricular arrhythmias associated with driving in more recent times. We agree about the enduring value of historic studies, and to paraphrase another famous quotation, "History is the present. That's why every generation writes it anew."


   References
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 References
 

  1. Albert CM, Rosenthal L, Calkins H, et al. Driving and implantable cardioverter-defibrillator shocks for ventricular arrhythmias: results from the TOVA study J Am Coll Cardiol 2007;50:2233-2240.[Abstract/Free Full Text]
  2. Littler WA, Honour AJ, Sleight P. Direct arterial pressure and electrocardiogram during motorcar driving BMJ 1973;2:273-277.[ISI][Medline]
  3. Taggart P, Gibbons D. Motor-car driving and heart rate Br Med J 1967;1:411-412.[ISI][Medline]
  4. Taggart P, Gibbons D, Somerville W. Some effects of motorcar driving on normal and abnormal heart rate BMJ 1969;4:130-134.[ISI][Medline]

Related Article

Driving and Ventricular Arrhythmia: A Historical Perspective
Rodney H. Falk
J. Am. Coll. Cardiol. 2008 52: 316. [Full Text] [PDF]




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