Consensus statement of the European Heart Rhythm Association: Updated recommendations for driving by patients with implantable cardioverter defibrillators☆

Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document.

		Restriction for private driving	Restriction for professional driving
	ICD implantation for secondary prevention	Three months	Permanent
	ICD implantation for primary prevention	Four weeks	Permanent
	After appropriate ICD therapy	Three months	Permanent
	After inappropriate ICD therapy	Until measures to prevent inappropriate therapy are taken	Permanent
	After replacement of the ICD	One week	Permanent
	After replacement of the lead system	Four weeks	Permanent
	Patients refusing ICD for primary prevention	No restriction	Permanent
	Patients refusing ICD implantation for secondary prevention	Seven months	Permanent

Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.