Ventricular Tachyarrhythmia
Ventricular Tachyarrhythmia
This question is difficult to answer. A patient treated with antiarrhythmic drugs or an internal defibrillator may have an episode of ventricular tachyarrhythmia despite treatment -- which could lead to an accident if the patient is driving at the time of the episode. But, a patient who is being treated for ventricular tachyarrhythmia might also have an accident while driving that is unrelated to the occurrence of an arrhythmia. In both cases, however, the legal profession may conclude that the individual should not have been allowed to drive an automobile.
Recently, Toshio Akiyama and colleagues studied this problem; they offer the best scientific information available on this subject in their current article. Of 627 patients who drove a motor vehicle prior to diagnosis in the Antiarrhythmics Versus Implantable Defibrillator (AVID) trial, 57% resumed driving within 3 months of treatment, 78% within 6 months, and 88% within 12 months. In 2% of cases, patients had episodes thought to be arrhythmic while driving; 11% had an apparent episode severe enough to stop their automobile, while 22% of patients had apparent episodes not serious enough to stop their automobile. Eight percent of 295 patients with internal defibrillators received a shock. There were 55 accidents during 1619 patient-years of follow-up (3.4 per patient year), and 11% were preceded by symptoms thought to be arrhythmic (0.4 per patient year).
This excellent study reveals that accidents are uncommon in the treated patients and occur less often than accidents in other driving populations. How physicians use this information to advise patients will, of course, vary considerably: There is a vast difference between driving on an expressway that passes through a busy city and driving in a small town where traffic problems rarely occur.
This question is difficult to answer. A patient treated with antiarrhythmic drugs or an internal defibrillator may have an episode of ventricular tachyarrhythmia despite treatment -- which could lead to an accident if the patient is driving at the time of the episode. But, a patient who is being treated for ventricular tachyarrhythmia might also have an accident while driving that is unrelated to the occurrence of an arrhythmia. In both cases, however, the legal profession may conclude that the individual should not have been allowed to drive an automobile.
Recently, Toshio Akiyama and colleagues studied this problem; they offer the best scientific information available on this subject in their current article. Of 627 patients who drove a motor vehicle prior to diagnosis in the Antiarrhythmics Versus Implantable Defibrillator (AVID) trial, 57% resumed driving within 3 months of treatment, 78% within 6 months, and 88% within 12 months. In 2% of cases, patients had episodes thought to be arrhythmic while driving; 11% had an apparent episode severe enough to stop their automobile, while 22% of patients had apparent episodes not serious enough to stop their automobile. Eight percent of 295 patients with internal defibrillators received a shock. There were 55 accidents during 1619 patient-years of follow-up (3.4 per patient year), and 11% were preceded by symptoms thought to be arrhythmic (0.4 per patient year).
This excellent study reveals that accidents are uncommon in the treated patients and occur less often than accidents in other driving populations. How physicians use this information to advise patients will, of course, vary considerably: There is a vast difference between driving on an expressway that passes through a busy city and driving in a small town where traffic problems rarely occur.
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