ICD stands for implantable cardioverter defibrillator. This is a device implanted in patients suffering from heart problems such as coronary artery disease or dilated cardiomyopathy. An ICD is a battery-operated implant that detects and responds abnormal rhythms of the heart or arrhythmias. Once an arrhythmia is detected, the device applies an electrical jolt to restore the heart rhythm back to normal. Over the years, ICDs have saved thousands of lives.
Recently, the European Society of Cardiology (ESC), in conjunction with other European health organizations that included European Heart Rhythm Association (EHRA), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR) issued a consensus statement that outlined restrictions on driving of motor vehicles by patients with ICDs. ESC made the announcement at the Europace 2009 sessions. The consensus statement was published in the EHRA journal Europace June 13, 2009 online issue.
The restrictions made a distinction between the types of vehicles as well as the type of drivers. Stricter regulations apply to driving trucks, buses and other large professional vehicles compare to small personal vehicles. There are also regulations that apply to patients who spend long periods of time behind the wheel as part of their jobs or professional life.
So what does an ICD actually does to the patient that may cause problems when driving a vehicle?
According to the UK-based Arrhythmia Alliance, most modern ICDs work n 3 ways:
- If your heart rhythm is too slow, the device can give your heart extra beats by working as a normal pacemaker. This is called anti-bradycardia pacing
- If your heart beats too fast, the ICD can give you a burst of extra beats at an even faster rate which will normally return your heart back to a normal rhythm. This is called anti-tachycardia pacing (or ATP)
- If the anti-tachycardia pacing doesn’t bring your heart back to a normal rhythm, or if the ICD senses a faster rhythm called ventricular fibrillation, the ICD can then give a higher energy shock. This is called defibrillation.
It is feared that at the moment when the ICD applies the electric shock, the patient sitting behind the wheel might lose control of the vehicle he is driving.
According to Dr Johan Vijgen, chairperson of the task force that developed the recommendations
“Driving restrictions vary across different countries in Europe. We hope the document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.”
The restrictions aim to protect the patients as well as other drivers of vehicles.
ICDs had some bad publicity last year mainly due to some product recalls as well as study results that indicated some people have implanted ICDs which they don’t and would never need. The latest restrictions on driving by ICD patients wouldn’t make this device any more popular.
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