DREAM-ICD-II Study.

Area of Science:

• Cardiology
• Medical Devices
• Public Health

Background:

• Current guidelines recommend a 6-month driving restriction post-secondary prevention implantable cardioverter-defibrillator (ICD) implantation.
• These restrictions cause significant inconvenience and social implications for patients.

Purpose of the Study:

• To evaluate the incidence rate of appropriate device therapies in contemporary secondary prevention ICD recipients.
• To assess the safety and efficacy of current driving restriction guidelines.

Main Methods:

• Retrospective study involving 721 patients who received new secondary prevention ICD implants.
• Follow-up median of 760 days across 3 Canadian tertiary care centers (2016-2020).

Main Results:

• The risk of ventricular arrhythmia was highest in the first 3 months (34.4%), decreasing significantly thereafter.
• Incidence rates per 100 patient-days for appropriate therapies declined from 0.48 at 90 days to 0.21 at 365 days (P<0.001).
• Cumulative incidence of sudden cardiac incapacitation dropped from 1.8% within 90 days to 0.4% between 91-180 days (P<0.001).

Conclusions:

• The incidence of appropriate therapies and sudden cardiac incapacitation is lower than previously reported and declines substantially after 3 months.
• Reducing driving restrictions to 3 months post-ICD implantation appears safe.
• Existing guidelines for driving restrictions after secondary prevention ICD implantation should be reconsidered.