{"id":131574,"date":"2023-06-07T07:51:39","date_gmt":"2023-06-07T07:51:39","guid":{"rendered":"https:\/\/ccs.ca\/?post_type=guideline&p=131574"},"modified":"2023-06-07T08:22:47","modified_gmt":"2023-06-07T08:22:47","slug":"chapter-2-driving-cardiac-rhythm-arrhythmia-device-and-procedures","status":"publish","type":"guideline","link":"https:\/\/ccs.ca\/fr\/guideline\/drive-and-fly-2003\/chapter-2-driving-cardiac-rhythm-arrhythmia-device-and-procedures\/","title":{"rendered":"2. Driving: Cardiac Rhythm, Arrhythmia Device and Procedures"},"content":{"rendered":"\n
VF (no reversible cause)<\/p>
Hemodynamically unstable VT<\/p>
VT or VF due to reversible cause*<\/p>
Sustained VT with no associated impairment of consciousness; LVEF<30%<\/p>
Sustained VT with no associated impairment of consciousness; LVEF\u226530%; ICD has not been recommended<\/p>
Nonsustained VT with no associated impairment of consciousness<\/p>
*Examples include, but are not limited to, ventricular fibrillation (VF) within 24 hrs of myocardial infarction, VF during coronary angiography, VF with electroncution and VF secondary to drug toxicity. Reversible-cause VF recommendations overrule the VF recommendations if the reversible cause is treated successfully and the VF does not recur.<\/p>\n\n\n\n
With impaired level of conciousness<\/p>
Without impaired level of conciousness<\/p>
N.B. Drivers should receive chronic anticoagulation is clinically indicated (i.e. in the presense of atrial fibrillation or atrial flutter).<\/p>\n\n\n\n
Adequate ventricular rate control; no impaired level of consciousness<\/p>
No associated symptoms<\/p>
No associated symptoms<\/p>
Associated symptoms (sick sinus syndrome)<\/p>
Isolated first degree AV block<\/p>
Isolated right bundle branch block (RBBB)<\/p>
Isolated left anterior fascicular block<\/p>
Isolated left posterior fascicular block<\/p>
Left bundle branch block (LBBB)<\/p>
Bifascicular block<\/p>
Second-degree AV block; Mobitz I<\/p>
First-degree AV block + bifascicular block<\/p>
Second-degree AV block; Mobitz II (distal AV block)<\/p>
Alternating LBBB and RBBB<\/p>
Acquired third-degree AV block<\/p>
Congenital third-degree AV block<\/p>
If a permanent pacemaker is implanted, the recommendations in the permanent pacemaker section prevail.<\/p>\n\n\n\n
All patients<\/p>
Primary prophylaxis, NYHA Class I-III<\/p>
A primary prophylaxis ICD has been recommended but declined by the patient<\/p>
Secondary prophylaxis for VF or VT with decreased level of conciousness; NYHA Class I-III<\/p>
Secondary prophylaxis for sustained VT with no associated cerebral ischemia; NYHA Class I-III<\/p>
Any event resulting in device therapies being delivered (shock or ATP), in which level of conciousness was impaired, or the therapy(ies) delivered by the device was\/were disabling<\/p>
*The 6 month period begins not at the time of ICD implant, but rather at the time of the last documented episode of sustained symptomatic ventricular tachycardia (VT), or syncope judged to be likely due to VT or cardiac arrest. For patients who have a bradycardia indication for pacing as well, the additional criteria under the permanent pacemaker section also apply. All patients must be followed from a technical standpoint in a device clinic with appropriate expertise.<\/p>\n\n\n\n
**ICDs may sometimes be implanted in low-risk patients. Individual cases may be made for allowing a commercial driver to continue driving with an ICD provided the annual risk of sudden incapacitation is believed to be 1% or less.<\/p>\n\n\n\n
Brugada’s syndrome; Long QT syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)<\/p>
Catheter ablation procedure; EPS with no inducible sustained ventricular arrhythmias<\/p>
*Inherited heart diseases may sometimes be indentified to pose a very low risk to patients. Individual cases can sometimes be made to allow a commercial driver to continue driving despite the diagnosis of one of these diseases, provided the annual risk of sudden incapacitation is believed to be 1% or less.<\/p>\n","protected":false},"featured_media":0,"parent":131566,"menu_order":1,"template":"guideline-chapter.php","topic":[],"resource_type":[],"acf":[],"yoast_head":"\n