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May 4, 1994

Recurrent Cardiac Events in Survivors of Ventricular Fibrillation or TachycardiaImplications for Driving Restrictions

Author Affiliations

From the Cardiology Section, Portland Veterans Affairs Medical Center (Dr Larsen), and the Arrhythmia Service, Cardiology Division, Department of Medicine, Oregon Health Sciences University, Portland (Drs Larsen, Cutler, Kron, and McAnulty, Mr Walance, and Ms Griffith). Dr Stupey was a medical student at Oregon Health Sciences University at the time of this study and is now with the Department of Psychiatry, University of Texas-San Antonio. Dr Cutler is now with Maine Cardiology Associates, Portland.

JAMA. 1994;271(17):1335-1339. doi:10.1001/jama.1994.03510410047031

Objective.  —To determine when survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) might most safely return to driving.

Design.  —Consecutive case series of 501 VT and VF survivors discharged alive between August 1978 and October 1989 and followed from 0 to 117 months (mean, 26 months).

Setting.  —Cardiac arrhythmia service of a university hospital.

Patients.  —The study group comprised 290 consecutive patients with sustained VT and 211 patients with VF who underwent electrophysiological studies and were discharged alive (78% male; mean age, 59 years). The mean ejection fraction (available in 338 patients) was 0.42.

Interventions.  —Antiarrhythmic drug testing for all patients was guided by serial electrophysiological testing. Overall, 227 patients (45%) were discharged on conventional antiarrhythmic agents, 115 (23%) on amiodarone, 39 (8%) received an implantable defibrillator, and 120 (24%) received no specific antiarrhythmic therapy.

Main Outcome Measures.  —Main outcomes included any event that could hamper a patient's ability to operate a motor vehicle. Specifically, these events included recurrent VF, poorly tolerated, hemodynamically unstable VT, syncope, sudden cardiac death, and implantable defibrillator discharge.

Results.  —Event risks were assessed during the first year after hospital discharge because that is when most patients decide whether to begin driving again. The 1-year outcome event rate for all 501 patients was 17%. Three distinct periods of risk were identified. The monthly hazard rate was highest in the first month after hospital discharge (4.22% per month), intermediate in months 2 through 7 (1.81% per month), and lowest in months 8 through 12 (0.63% per month). The 191 patients for whom no successful conventional antiarrhythmic drug could be found during electrophysiological testing experienced a persistently high monthly event risk (1.6%) during months 8 through 12.

Conclusions.  —All survivors of VT or VF should refrain from driving during the first month after hospital discharge when the hazard for events that could impair their ability to drive is greatest. Our data would support restricting driving for most patients until the eighth month after hospital discharge, when risk becomes lowest. Restriction might be lengthened in patients for whom electrophysiological testing finds no satisfactory conventional antiarrhythmic agent because their risk remains higher than average even after 7 months. Individualized recommendations should be allowed because the accident rate for patients who actually suffer sudden death is low.(JAMA. 1994;271:1335-1339)