Recurrent Cardiac Events in Survivors of Ventricular Fibrillation or Tachycardia: Implications for Driving Restrictions

Abstract

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…