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Canadian Journal of Cardiology

Driving Restrictions and Early Arrhythmias in Patients Receiving a Primary-Prevention Implantable Cardioverter-Defibrillator (DREAM-ICD) Study

      Abstract

      Background

      Current guidelines recommend 4 weeks of private driving restriction after implantation of a primary-prevention implantable cardioverter-defibrillator (ICD). These driving restrictions result in significant inconvenience and social implications. Advances in medical treatment and ICD programming have lowered the overall rate of device therapies. The objective of this study was to assess the incidence of ICD therapies at 30, 60, and 180 days after implantation.

      Methods

      Driving Restrictions and Early Arrhythmias in Patients Receiving a Primary-Prevention Implantable Cardioverter-Defibrillator (DREAM-ICD) was a retrospective cohort study conducted at 2 Canadian university centres enrolling patients with new implantation of a primary-prevention ICD. Device programming was standardised according to current guidelines. A total of 803 patients were enrolled.

      Results

      The cumulative rates of appropriate ICD therapies at 30, 60, and 180 days were 0.12%, 0.50%, and 0.75%, respectively. There was no syncope during the first 6 months. The median duration to the first appropriate ICD therapy was 208 (range 23-1109) days after implantation. The rate of inappropriate ICD therapies at 30 days was only 0.2%. Overall, < 13.6% of all appropriate ICD therapies occurred within the first 6 months after implantation.

      Conclusions

      The rate of appropriate ICD therapies within the first 30 days after device insertion is extremely low in contemporary primary prevention cohorts with guideline-concordant device programming. There was no increased risk for ventricular arrhythmia early after ICD insertion. The results of DREAM-ICD suggest the need for a revision of the existing driving restrictions for primary-prevention ICD recipients.

      Résumé

      Contexte

      En vertu des recommandations actuelles, les patients qui reçoivent un défibrillateur cardioverteur implantable (DCI) en prévention primaire ne doivent pas conduire un véhicule pendant quatre semaines après l’implantation du dispositif. Cette restriction entraîne des désagréments considérables et a des répercussions sur le plan social. Les progrès réalisés en matière de traitements médicaux et de programmation des DCI ont fait diminuer la fréquence globale des traitements administrés par le dispositif. L’étude présentée visait à évaluer l’incidence des traitements par DCI à 30, à 60 et à 180 jours après l’implantation du dispositif.

      Méthodologie

      L’étude Driving Restrictions and Early Arrhythmias in Patients Receiving a Primary-Prevention Implantable Cardioverter-Defibrillator (DREAM-ICD) était une étude de cohorte rétrospective menée dans deux établissements universitaires canadiens auprès de patients ayant reçu un DCI en prévention primaire. Les dispositifs étaient programmés de façon normalisée, selon les lignes directrices en vigueur. Au total, 803 sujets ont été retenus aux fins de l’étude.

      Résultats

      Les fréquences cumulatives des traitements par DCI appropriés à 30, à 60 et à 180 jours s’établissaient respectivement à 0,12 %, à 0,50 % et à 0,75 %. Aucun patient n’a subi de syncope dans les six mois suivant l’implantation du dispositif. L’intervalle médian avant le premier traitement par DCI approprié était de 208 jours (extrêmes : 23 et 1109) après l’implantation. La fréquence des traitements par DCI inappropriés à 30 jours s’établissait à seulement 0,2 %. Dans l’ensemble, < 13,6 % de tous les traitements par DCI appropriés sont survenus dans les six mois suivant l’implantation.

      Conclusions

      La fréquence des traitements par DCI appropriés au cours des 30 jours suivant l’implantation du dispositif était extrêmement faible dans les cohortes contemporaines de patients traités en prévention primaire au moyen d’un dispositif programmé selon les lignes directrices en vigueur. On n’a observé aucune augmentation du risque d’arythmie ventriculaire peu après l’implantation d’un DCI. Les résultats de l’étude DREAM-ICD semblent indiquer qu’il conviendrait de revoir les restrictions actuelles concernant la conduite d’un véhicule après l’implantation d’un DCI en prévention primaire.
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