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Gutiérrez OJ. Cardiac implantable devices during exercise: Normal function and troubleshooting. J Arrhythm 2021; 37:660-668. [PMID: 34141019 PMCID: PMC8207372 DOI: 10.1002/joa3.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Normal function and the most common problems that occur during pacemaker operation while performing physical exercise, are discussed. Physically active individuals with an implantable cardiac device, should be evaluated during exercise, because some conflicts issues may arise that are not detectable during routine, at rest, telemetry.
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Kossaify A. Sensing and Detection Functions in Implantable Cardioverter Defibrillators: The Good, the Bad and the Ugly. ACTA CARDIOLOGICA SINICA 2020; 36:308-317. [PMID: 32675922 PMCID: PMC7355121 DOI: 10.6515/acs.202007_36(4).20191201a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/01/2019] [Indexed: 12/17/2022]
Abstract
Implantable cardioverter defibrillators are small devices that have been proven to be beneficial by preventing sudden cardiac death, whether in primary or secondary prevention. Appropriate functioning of implantable cardioverter defibrillators is mainly dependent on the "good" sensing of ventricular electrogram waves, allowing for the adequate detection of ventricular arrhythmias in order to deliver appropriate therapy of either antitachycardia pacing or by delivering a shock according to the detected rhythm. Basic sensing function in defibrillators is based on detection rate and detection duration; additional parameters that are involved in the process of adequate detection include ventricular electrogram sensing, auto-adjusting sensitivity, supraventricular arrhythmia discrimination criteria, noise detection, and various dedicated algorithms. Defective sensing may result in the delivery of inappropriate therapy (oversensing) or inappropriate withholding of therapy (undersensing); the latter of which may lead to sudden cardiac death. This paper describes different clinical scenarios and programming tips to avoid abnormal or critical clinical situations.
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Affiliation(s)
- Antoine Kossaify
- Cardiology Department, Arrhythmia Division, University Hospital Notre Dame des Secours/USEK, Byblos, Lebanon
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Zdarek J, Israel CW. Detection and discrimination of tachycardia in ICDs manufactured by St. Jude Medical. Herzschrittmacherther Elektrophysiol 2016; 27:226-239. [PMID: 27605236 DOI: 10.1007/s00399-016-0455-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
Modern implantable cardioverter/defibrillator (ICD) systems offer a multitude of algorithms to optimize performance in sensing and tachycardia detection even in difficult circumstances (e. g., ventricular tachycardia during supraventricular tachycardia, fine ventricular fibrillation with intermittent undersensing), to reliably discriminate sustained ventricular tachyarrhythmia from noise, nonsustained and supraventricular tachyarrhythmia, and to limit shock therapy only to those arrhythmias that definitely need to be treated by a shock. A disadvantage of these multiple algorithms is the complexity of annotated tracings that makes it sometimes difficult to understand why the ICD did what it did. If a tachycardia classification was wrong, it may be thus difficult to find the best way to reprogram the device to avoid another misclassification. This review explains in detail the algorithms used for tachycardia detection, discrimination, and prevention of inappropriate therapy in single- and dual-chamber ICDs manufactured by St. Jude Medical. Knowledge of these features may help to optimize ICD treatment in patients fitted with these devices.
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Affiliation(s)
- Jan Zdarek
- St. Jude Medical, Helfmann-Park 7, 65760, Eschborn, Germany.
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Sawhney V, Campbell N, Brouilette S, Coppen S, Harbo M, Baker V, Ikebe C, Shintani Y, Hunter R, Dhinoja M, Johnston A, Earley M, Sporton S, Bendix L, Suzuki K, Schilling R. Telomere shortening and telomerase activity in ischaemic cardiomyopathy patients – Potential markers of ventricular arrhythmia. Int J Cardiol 2016; 207:157-63. [DOI: 10.1016/j.ijcard.2016.01.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/09/2015] [Accepted: 01/01/2016] [Indexed: 11/25/2022]
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Reduced Risk for Inappropriate Implantable Cardioverter-Defibrillator Shocks With Dual-Chamber Therapy Compared With Single-Chamber Therapy. JACC-HEART FAILURE 2014; 2:611-9. [DOI: 10.1016/j.jchf.2014.05.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/14/2014] [Accepted: 05/17/2014] [Indexed: 11/21/2022]
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Rajamani K, Goldberg AS, Wilkoff BL. Shock Avoidance and the Newer Tachycardia Therapy Algorithms. Cardiol Clin 2014; 32:191-200. [DOI: 10.1016/j.ccl.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sullivan RM, Seth M, Berg K, Stolen KQ, Jones PW, Russo AM, Gilliam FR, Olshansky B. Does change in device detected frequency of non-sustained or diverted episodes serve as a marker for inappropriate shock therapy? Analyses from the INTRINSIC RV and ALTITUDE-REDUCES Trials. Europace 2014; 16:668-73. [PMID: 24489072 DOI: 10.1093/europace/eut426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Implantable cardioverter-defibrillators (ICDs) treat ventricular tachycardia or fibrillation but may also deliver unnecessary shocks. We sought to determine if the frequency of ICD-detected non-sustained or diverted (NSD) episodes increases before appropriate or inappropriate ICD shocks. METHODS AND RESULTS We evaluated NSD episodes in the INTRINSIC RV Trial and their relationship to ICD shocks (appropriate and inappropriate). Time from NSD to shock was analysed. Results were validated by utilizing 1495 adjudicated ICD and cardiac resynchronization therapy-defibrillator shocks following NSD episodes collected through the LATITUDE remote monitoring system as part of the ALTITUDE-REDUCES Study. In INTRINSIC RV, 185 participants received 373 shocks; 148 had at least 1 NSD episode. Non-sustained or diverted frequency increased 24 h before the first shock for those receiving an inappropriate (P < 0.01) but not an appropriate shock (P = 0.17). Patients with NSD episodes within 24 h of a shock were significantly more likely to receive inappropriate therapy [odds ratio (OR) = 3.12, P < 0.01]. At the receiver operator curve determined optimal cutoff, an NSD episode within 14 min before shock strongly predicted inappropriate therapy (sensitivity 48%, specificity 91%; OR = 8.8, and P < 0.001). The 14 min cut-off evaluated on an independent dataset of 1495 shock episodes preceded by an NSD in the ALTITUDE-REDUCES Study confirmed these results (sensitivity = 47%, specificity = 85%, OR = 5.0, and P < 0.001). CONCLUSION Device-detected NSD episodes increase before inappropriate but not appropriate shocks. Novel alerts or automated algorithms based on NSD episodes may reduce inappropriate shocks.
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Abstract
The ventricular tachycardia (VT) monitoring zone in implantable cardioverter defibrillators (ICDs) is usually programmed to detect slow VTs. However, it is not well known whether programming this zone can affect the ICD arrhythmia redetection or confirmation criteria. We report two cases of inappropriate ICD shocks due to the programming of a slow VT monitoring zone in the same device model.
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Gonçalves J, Pereira T. Inappropriate shocks in patients with ICDs: single chamber versus dual chamber. Arq Bras Cardiol 2013; 101:141-8. [PMID: 23821405 PMCID: PMC3998159 DOI: 10.5935/abc.20130125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 03/18/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite the technological evolution of the implantable defibrillator, one of the questions that remains is the possible benefit of the dual chamber versus single chamber implantable cardioverter defibrillator (ICD) in reducing inappropriate shocks. OBJECTIVE To evaluate which type of device provides fewer inappropriate shocks (dual chamber versus single chamber) in patients with implantable cardioverter defibrillators (ICDs). METHODS Meta-analysis of randomized studies published in the literature comparing dual-chamber implantable cardioverter defibrillators to single chamber devices which have been known to cause, as an evaluated endpoint, inappropriate shocks. RESULTS The dual-chamber implantable cardioverter showed no benefit in reducing the number of inappropriate shocks. In fact, the opposite was shown. In the analysis of fixed effects, the association tended to favor single-chamber implantable cardioverter defibrillators (OR = 1.53, CI 95%: 0.91-2.57), despite the absence of statistical significance (p = 0.11). We highlight the heterogeneity observed in the results (I² = 53%), which motivated a replication of the analysis using a model of random effects. However, significant differences remained in the occurrence of inappropriate shocks in both groups (OR = 1.1, 95% CI: 0.37-3.31; p = 0.86). To complement the analysis, we proceeded to perform sensitivity analysis, which showed that the exclusion of a study resulted in the lowest heterogeneity observed (I²=24%) and the association with inappropriate shocks significantly favored the single chamber cardiodefibrillator (OR = 1.91; 95% CI: 1.09-3.37; p = 0.27). CONCLUSIONS It was determined that there was no clear evidence of superiority of any of the devices evaluated.
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Affiliation(s)
- Juliana Gonçalves
- Departamento de Cardiopneumologia - Escola Superior de Tecnologia da
Saúde de Coimbra
- Mailing Address: Juliana Figueiredo Gonçalves, Estrada Nacional 102, nº
53, Artesanato 'O Tear'. Postal Code 5150-644, Vila Nova de Foz Côa, Guarda,
Portugal, E-mail:
| | - Telmo Pereira
- Departamento de Cardiopneumologia - Escola Superior de Tecnologia da
Saúde de Coimbra
- Departamento de Cardiopneumologia - Faculdade de Ciências da Saúde -
Universidade Metodista de Angola
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de Asmundis C, Ricciardi D, Namdar M, Chierchia GB, Sarkozy A, Brugada P. Role of home monitoring in children with implantable cardioverter defibrillators for Brugada syndrome. ACTA ACUST UNITED AC 2013; 15 Suppl 1:i17-i25. [DOI: 10.1093/europace/eut112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ethical and legal perspective of implantable cardioverter defibrillator deactivation or implantable cardioverter defibrillator generator replacement in the elderly. Curr Opin Cardiol 2013; 28:43-9. [DOI: 10.1097/hco.0b013e32835b0b3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tzeis S, Andrikopoulos G. Antiarrhythmic properties of ranolazine – from bench to bedside. Expert Opin Investig Drugs 2012; 21:1733-41. [DOI: 10.1517/13543784.2012.716826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Matsuzaki H, Nakano Y, Okahara S, Miyamoto S, Takahashi H, Imai K, Sueda T, Kihara Y. Monitoring zone-associated implantable cardioverter defibrillator shock: A case report. J Arrhythm 2012. [DOI: 10.1016/j.joa.2011.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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ICD-Therapie 2011. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Perings C, Bauer WR, Bondke HJ, Mewis C, James M, Böcker D, Broadhurst P, Korte T, Toft E, Hintringer F, Clémenty J, Schwab JO. Remote monitoring of implantable-cardioverter defibrillators: results from the Reliability of IEGM Online Interpretation (RIONI) study. Europace 2011; 13:221-9. [PMID: 21252195 DOI: 10.1093/europace/euq447] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Intracardiac electrograms (IEGMs) recorded by implantable cardioverter-defibrillators (ICDs) are essential for arrhythmia diagnosis and ICD therapy assessment. Short IEGM snapshots showing 3-10 s before arrhythmia detection were added to the Biotronik Home Monitoring system in 2005 as the first-generation IEGM Online. The RIONI study tested the primary hypothesis that experts' ratings regarding the appropriateness of ICD therapy based on IEGM Online and on standard 30 s IEGM differ in <10% of arrhythmia events. METHODS AND RESULTS A total of 619 ICD patients were enrolled and followed for 1 year. According to a predefined procedure, 210 events recorded by the ICDs were selected for evaluation. Three expert board members rated the appropriateness of ICD therapy and classified the underlying arrhythmia using coded IEGM Online and standard IEGM to avoid bias. The average duration of IEGM Online was 4.4±1.5 s. According to standard IEGM, the underlying arrhythmia was ventricular in 135 episodes (64.3%), supraventricular in 53 episodes (25.2%), oversensing in 17 episodes (8.1%), and uncertain in 5 episodes (2.4%). The expert board's rating diverged between determinable IEGM Online tracings and standard IEGM in 4.6% of episodes regarding the appropriateness of ICD therapy (95% CI up to 8.0%) and in 6.6% of episodes regarding arrhythmia classification (95% CI up to 10.5%). CONCLUSION By enabling accurate evaluation of the appropriateness of ICD therapy and the underlying arrhythmia, the first-generation IEGM Online provided a clinically effective basis for timely interventions and for optimized patient management schemes, which was comparable with current IEGM recordings.
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Affiliation(s)
- Christian Perings
- Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Bochum, Germany.
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Maesato A, Higa S, Lin YJ, Chinen I, Ishigaki S, Yajima M, Masuzaki H, Chen SA. Impact of Pacing and High-Pass Filter Settings on Ventricular Bipolar Electrograms in Implantable Cardioverter Defibrillator Systems - Implication of Predictors for Inappropriate Therapy Caused by Oversensing of Repolarization Electrograms -. Circ J 2011; 75:2095-104. [DOI: 10.1253/circj.cj-11-0200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akira Maesato
- Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital
| | - Satoshi Higa
- Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital
| | - Ichiro Chinen
- Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
| | - Sugako Ishigaki
- Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital
| | - Machiko Yajima
- Department of Medical Engineering, University of the Ryukyus
| | - Hiroaki Masuzaki
- Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital
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KOLB CHRISTOF, TZEIS STYLIANOS, STURMER MARCIO, BABUTY DOMINIQUE, SCHWAB JÖRGO, MANTOVANI GIUSEPPE, JANKO SABINE, AIMÉ EZIO, OCKLENBURG ROLF, SICK PETER. Rationale and Design of the OPTION Study: Optimal Antitachycardia Therapy in ICD Patients without Pacing Indications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1141-8. [DOI: 10.1111/j.1540-8159.2010.02790.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DUNCAN EDWARD, THOMAS GLYN, JOHNS NEVILLE, PFEFFER CAMERON, APPANNA GAUTHAM, SHAH NIRAV, HUNTER ROSS, FINLAY MALCOLM, SCHILLING RICHARDJ, SPORTON SIMON. Do Traditional VT Zones Improve Outcome in Primary Prevention ICD Patients? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1353-8. [DOI: 10.1111/j.1540-8159.2010.02859.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wazni O, Wilkoff BL. Strategic choices to reduce implantable cardioverter-defibrillator-related morbidity. Nat Rev Cardiol 2010; 7:376-83. [DOI: 10.1038/nrcardio.2010.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus Statement: Consensus Statement of the European Heart Rhythm Association: Updated Recommendations for Driving by Patients with Implantable Cardioverter Defibrillators. Eur J Cardiovasc Nurs 2010; 9:3-14. [PMID: 20170847 DOI: 10.1016/j.ejcnurse.2010.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Johan Vijgen
- Department of Cardiology, Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - Gianluca Botto
- Department of Cardiology, St. Anna Hospital, Como, Italy
| | - John Camm
- Department of Cardiac and Vascular Sciences, St. George's University, London, United Kingdom
| | | | - Werner Jung
- Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany
| | | | - Andrzej Lubinski
- Department of Interventional Cardiology, Medical University of Lodz, Poland
| | - Tone M. Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Schmid
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion Crete, Greece
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators. Europace 2009; 11:1097-1107. [PMID: 19525498 DOI: 10.1093/europace/eup112] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document. [table: see text] Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.
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