DRIVING RESTRICTIONS AND EARLY ARRHYTHMIAS IN PATIENTS RECEIVING A PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (DREAM-ICD STUDY)

Abstract Background Current guidelines recommend 4 weeks of private driving restriction after implantation of a primary prevention implantable cardioverter defibrillator (ICD). These driving restrictions result in significant inconvenience and social implications. Advances in medical treatment and ICD programming have lowered the overall rate of device therapies. The objective of the study was to assess the incidence of ICD therapies at 30, 60 and 180 days after implantation. Methods and Results DREAM-ICD is a retrospective cohort study that was conducted at 2 Canadian university centers enrolling patients with new implantation of a primary prevention ICD. Device programming was standardized according to current guidelines. A total of 803 patients were enrolled. The cumulative rate of appropriate ICD therapies at 30, 60 and 180 days was 0.12%, 0.50% and 0.75% respectively. There was no syncope during the first 6 months. The median duration to the first appropriate ICD therapy was 208 (range 23-1109) days after implantation. The rate of inappropriate ICD therapies at 30 days was only 0.2%. Overall, less than 13.6% of all appropriate ICD therapies occurred within the first 6 months after implantation. Conclusions The rate of appropriate ICD therapies within the first 30 days after device insertion is extremely low in contemporary primary prevention cohorts with guideline-concordant device programming. There was no increased risk for ventricular arrhythmia early after ICD insertion. The results of DREAM-ICD suggest the need for a revision of the existing driving restrictions for primary prevention ICD recipients.