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Topic 948 Version 27.0 https://www.uptodate.com/contents/driving-restrictions-in-patients-with-an-implantable-cardioverter-defibrillator/print 16/20 7/6/23, 10:51 AM Driving restrictions in patients with an implantable cardioverter-defibrillator - UpToDate GRAPHICS Driving restrictions in patients with ICD and pacemaker in four countries/regions License Japan UK USA EU type Pacemaker implant Class 1 Cease driving for 1 week. Cease driving for 1 week. Cease driving for 1 week. Cease driving for 1 week. Class 2 Disqualified Cease driving for 6 Cease driving Disqualified if until pacemaker integrity is ascertained. weeks. for 4 weeks. persistent symptoms. ICD implant for VT/VF with incapacity (secondary prevention) Class 1 Cease for 6 months after first implant. Cease for 6 months after first implant. Cease for 6 months after first implant. Cease for 3 months. Class 2 Permanently bars. Permanently bars. Permanently bars. Permanently bars. ICD implant for sustained VT without Class 1 Cease for 6 months after first implant. Cease for 1 month after first implant provided all of the Cease for 6 months after implant. Cease for 3 months after implant. incapacity (secondary prevention) following are met: a. LVEF >35%. b. No fast VT on EPS. c. Any induced VT could be pace- terminated by the ICD twice, without acceleration, during the post- implantation study. Class 2 Permanently Permanently bars. Permanently Permanently bars. bars. bars. https://www.uptodate.com/contents/driving-restrictions-in-patients-with-an-implantable-cardioverter-defibrillator/print 17/20 7/6/23, 10:51 AM Driving restrictions in patients with an implantable cardioverter-defibrillator - UpToDate Prophylactic ICD implantation (primary prevention) Class 1 Cease for 1 week. Cease for 1 month. Cease for 1 week. Cease For 4 weeks. Class 2 Permanently bars. Permanently bars. Permanently bars. Permanently bars. ICD and lead Class 1 Cease For 1 Cease for 1 month No specific Cease For 4 system replacement week after replacement of the lead system or replacement of the ICD. after a revision of the leads or antiarrhythmic drug change. guidance. weeks after replacement of the ICD and lead system or the lead system alone. Cease For 1 week after replacement of ICD. Delivery of ICD therapy Class 1 Cease for 3 months after appropriate therapy. Appropriate shock plus symptomatic ATP: Cease for 6 months with corrective Cease for 6 months after appropriate therapy. Cease for 3 months after appropriate therapy. Inappropriate Inappropriate Inappropriate measures to prevent recurrence provided no further symptomatic therapy. therapy: no restrictions for asymptomatic episodes. Cease for 3 therapy: no distinction made from appropriate therapy. therapy: cease until cause of inappropriate therapy was corrected. months in case of syncope. Inappropriate therapy: cease for 1 month after the cause of the inappropriate therapy was corrected. Driving restrictions in various countries/regions. A class 1 license is a license to operate one's own vehicle for personal use, while a class 2 license is a commercial license for those who drive a vehicle for work. ICD: implantable cardioverter-defibrillator; VT: ventricular fibrillation; VF: ventricular fibrillation; LVEF: left ventricular ejection fraction; EPS: electrophysiologic test; ATP: antitachycardia pacing. Reproduced from: Watanabe E, Abe H, Watanabe S. Driving restrictions in patients with implantable cardioverter https://www.uptodate.com/contents/driving-restrictions-in-patients-with-an-implantable-cardioverter-defibrillator/print 18/20 7/6/23, 10:51 AM Driving restrictions in patients with an implantable cardioverter-defibrillator - UpToDate de brillators and pacemakers. J Arrhythm 2017; 33:594. Table used with the permission of Elsevier, Inc. All rights reserved. Graphic 120456 Version 1.0 https://www.uptodate.com/contents/driving-restrictions-in-patients-with-an-implantable-cardioverter-defibrillator/print 19/20 7/6/23, 10:51 AM Driving restrictions in patients with an implantable cardioverter-defibrillator - UpToDate Contributor Disclosures Kapil Kumar, MD No relevant financial relationship(s) with ineligible companies to disclose. N A Mark Estes, III, MD Consultant/Advisory Boards: Boston Scientific [Arrhythmias]; Medtronic [Arrhythmias]. All of the relevant financial relationships listed have been mitigated. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/driving-restrictions-in-patients-with-an-implantable-cardioverter-defibrillator/print 20/20