Recommendations for driving after implantable cardioverter defibrillator implantation and the use of a wearable cardioverter defibrillator

How to assess fitness to drive in patients with cardiac rhythm disturbances through an applicable decision support system

Disturbances in cardiac rhythm affect a significant fraction of the population; they can have an ample range of repercussions on one person's quality of life, from negligible to lethal. As an implication, arrhythmias concern many private, commercial and public-passenger-vehicle driving licence holders. In their practice, medical professionals can be asked to assess an arrhythmia patient's fitness to drive effectively. Due to the subject's complexity (requiring an extent of multidisciplinary competencies), the current guidances' heterogeneity and the possible ethical conflicts, the decision-making process becomes challenging and of particular concern to the doctor. To offer an applicable decision support system to doctors of various backgrounds to implement in their practice when asked to assess for fitness to drive in a patient with a suspected disease, a formulated diagnosis or subjected to therapy for cardiac rhythm disturbances, we started gathering the issues concerning the fitness assessment of drivers (or candidates) who present with any condition, symptom or treatment possibly or knowingly caused by cardiac rhythm disturbances. Subsequently, we reviewed the English-based literature, including various countries' published medical standards. Then, the overview was revised by local medical experts in clinical arrhythmology, electrophysiology and traffic medicine to reach a consensus statement at a local level. The result is an easily consultable operational protocol that lists conditions, symptoms or treatments caused or possibly caused by cardiac rhythm disturbances; the certifications required for the assessment of the driver (or candidate); the orientation about the fitness or unfitness to drive under the enlisted medical conditions (distinguishing between private and professional drivers); and the recommended time limits to revise the case. A particular focus is applied to patients subject to the remote monitoring system of an implantable cardiac device, as this innovative approach constitutes a solid and efficient instrument for an accurate evaluation of the patient's cardiovascular situation. Despite some limitations, mainly concerning the lack of information at the moment of the evaluation or the infrequency of the medical condition, this proposal offers a ready-to-use solution for doctors who are asked to give their professional (clinical or medico-legal) opinion about the fitness to drive of patients with an arrhythmia problem. As an advantage, the constant cooperation among professionals from different backgrounds, like electrophysiologists and traffic medicine experts, allows a more individual, less predetermined evaluation of the specific case.