Abstract 8809: Time Course of Appropriate ICD Therapy in Patients from the OMNI Registry: Implications for Duration of Driving Restriction.
Intro: AHA/HRS recommendations restrict driving in ICD patients (pts) for 6 months after implant for secondary prevention (SP) or primary prevention (PP) with an appropriate therapy (AT: antitachycardia pacing or shock) for ventricular arrhythmias (VA). Data supporting this are limited.
Methods: The OMNI Registry was queried for appropriate ICD therapies for VA and assessed for the time course to first AT and appropriate shock (AS). Time to 2nd and 3rd AT/AS was recorded in the overall group and selected subgroups: 1) syncope (S) vs no S (NS); 2) PP vs SP. Episodes were adjudicated by a blinded events committee.
Results: 2255 Pts, mean age 67 years (73 % M), mean LVEF 28 % were enrolled. Pts included both PP (74 %) and SP (26 %). S occurred in 22 % of pts prior to implant. Overall, 624/2255 pts (27.7 %) received a first AT in a mean of 13 ± 13 months post-implant. Of these, a 2nd or 3rd AT (AT2 or AT3, respectively) occurred in a mean of 5.4 ± 8.1 months (AT2 after AT1; 387/624; 62 %) and 3.1 ± 6.2 months (AT3 after AT2; 285/387; 74 %). 326/2255 pts (14.5 %) received a first AS (AS1) in a mean of 14.8 ± 13.7 months. 182/326 pts (56 %) had a second AS (AS2) in a mean of 4.1 ± 7.2 months; 117/182 pts (64 %) had a third AS (AS3) in a mean of 3.2 ± 7.1 months. In pts with S vs NS, both incidence and time to AT1/AS1 were similar. Rates of further AT/AS events were also similar with AS2 occurring at 4 months for both S and NS. Pts implanted for SP received both AT1 (mean 11 vs 14.3 months) and AS1 (mean 11.8 vs 16.6 months) earlier than PP pts. SP pts had higher rates of AT/AS after the first AT/AS (SP vs PP: AT2 70 % vs 58 %; AS2 72 % vs 47 %). In both PP and SP, AS2 occurred in about 4 months.
Conclusions: In this real world sample of ICD pts, guideline recommended 6 month driving restrictions appear more reasonable when applied after AS1 than AT1. Measured over the first 3 VA events, each VA increases the risk of a subsequent VA, and decreases the mean time to the subsequent VA. Such pts may require stricter driving restrictions than pts after a first VA event.
- © 2011 by American Heart Association, Inc.