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Letters |1 December 1995

More on Patients with Implantable Cardioverter-Defibrillators

Sergio L. Pinski, MD; Richard G. Trohman, MD

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Author, Article, and Disclosure Information
  • Cleveland Clinic Foundation; Cleveland, OH 44195
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IN RESPONSE:
We appreciate the comments of Embil and Geddes. Return to work after implantable cardioverter-defibrillator implantation is potentially complicated by several issues, including lead stability, driving, operating machinery when syncope might result in serious injury or death, and effects of electromagnetic interference.
Endocardial leads are infrequently dislodged after nonthoracotomy implantation of the defibrillator [1]. Although most dislodgments are detected before hospital discharge, optimal lead fixation requires several weeks. We recommend that patients avoid lifting more than 30 pounds and other vigorous arm movements for 6 weeks after lead placement.
Many physicians permit driving about 6 or 7 months after implantation of the defibrillator [2, 3], a decision influenced by state legislation. The hemodynamic stability of the patient's previous arrhythmic episodes should be considered. However, there is no guarantee that subsequent events will not be associated with loss of consciousness. The rate of motor vehicle accidents associated with discharge of implantable cardiac-defibrillators appears to be low; only 10% of discharges that occur while the patient is driving are associated with accidents. One study suggests that the number of injuries and deaths that occur during driving in patients with implanted defibrillators may be less frequent than that in the general population [3]. Most patients with implanted defibrillators drive, even if advised to avoid it permanently. Restrictions for a limited period may be appropriate, but lifelong driving abstinence seems unnecessary.
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Pinski SL, Trohman RG. More on Patients with Implantable Cardioverter-Defibrillators. Ann Intern Med. ;123:893. doi: 10.7326/0003-4819-123-11-199512010-00022

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Published: Ann Intern Med. 1995;123(11):893.

DOI: 10.7326/0003-4819-123-11-199512010-00022

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