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    Study: Patients With Serious Irregular Heartbeats Resume Driving Quickly

    Most patients who experience life-threatening heart irregularities called ventricular tacharrhythmia (VT) resume driving shortly after their heart problem is treated, according to the authors of a study in the August 9 issue of the New England Journal of Medicine. Symptoms of VT include dizziness, fainting, and palpitations.

    Tohio Akiyama, M.D., of the University of Rochester Medical Center, and his colleagues in a multi-center group reported that although many of these patients have symptoms of possible arrhythmia while driving, accidents are so rare that the patients have a lower rate of automobile accidents than does the U.S. population as a whole.

    The investigators sent questionnaires to patients who were already participating in a trial of two competing approaches for treating arrhythmias. Eighty-three percent of those to whom a questionnaire was sent responded.

    Only 64 percent of survey respondents reported that their doctor had discussed the issue of driving with them. Those who did receive advice from a doctor about driving reported a wide range of suggestions. Nine percent said their doctor had endorsed their returning to the road within one month after their episode of VT, four percent said the doctor had told them never to drive again, and five percent said the doctor had left the decision to their discretion. The most common advice was to resume driving within 6-11 months (25 percent).

    Ninety percent of respondents chose to resume driving. Two percent said they had lost consciousness while driving, and eleven percent reported dizziness or palpitations while driving that necessitated stopping the automobile.

    Responses to questionnaires indicated that the annual risk of an automobile accident after a life-threatening VT was 3.4 percent-of which 0.4 percent was presumed to be related to the patients heart conditions. On the other hand, 6.2 percent of patients reported having had an accident in the year before their enrollment in the trial. Thus, the annual rate of motor vehicle accidents among the study patients was 1.8 times as high before the index episode of VT (the VT episode which qualified the patient for participation in the study) as after the episode. There was no link between how long a patient waited before resuming driving and the likelihood of an accident.

    "Despite the low probability of a motor vehicle accident, symptoms that could result in sudden incapacitation [such as fainting and dizziness] occurred relatively frequently," the study s authors note.

    "Shortly after the initiation of treatment for life-threatening ventricular tacharrhythmia, most patients resume driving despite recommendations by their physicians that they refrain from doing so. Nevertheless, these patients appear to have a low risk of being in a motor vehicle accident-a risk that is not greater than that in the general driving population. The absence of a relationship between the duration of abstinence from driving and the probability of a motor vehicle accident indicates that patients who have been treated for ventricular tacharrhythmia should be permitted to drive as soon as their associated medical conditions allow," Akiyama and his colleagues conclude.

    An editorial in the same issue by Timothy W. Smith, D.Phil., M.D., of the Washington University School of Medicine, St. Louis, noted that one reason why the apparent risk of an accident is lower after the VT event is that only those patients who feel well enough to drive choose to do so-it may be that those who would account for many of the accidents are just staying off the road.



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