Cardioverter-Defibrillator Implantation as a Risk Factor For Motor Vehicle Crash

Staples, JA; Daly-Grafstein, D; Robinson, I; Khan, M; Hawkins, NM; Chan, H; Erdelyi, S; Steinberg, C; Maclure, KM; Krahn, AD; Brubacher, JR

doi:10.1016/j.jacep.2024.12.002

Cardioverter-Defibrillator Implantation as a Risk Factor For Motor Vehicle Crash

JACC Clin ElectrophysiolPublished 29 Jan 2025case-crossover design

Main finding · ICD implantation and subsequent crash (case-crossover analysis of crash-involved ICD recipients)ResultAdjusted odds ratio 0.86 95% CI 0.71–1.03

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Authors' conclusion

The 6-month interval after ICD implantation is not associated with increased odds of crash nor with increased likelihood of crash responsibility. Contemporary driving restrictions in the first weeks after ICD implantation appear to adequately mitigate the potential increase in crash risk.

Study context

Population: All drivers involved in a serious motor vehicle crash in British Columbia, Canada, from 1997 to 2019

Exposure: Implantable cardioverter-defibrillator (ICD) implantation in the 6 months before a crash
Outcome: ICD implantation and subsequent crash (case-crossover analysis of crash-involved ICD recipients)
Follow-up: 6 months

Methodological detailspopulation-based, responsibility design, logistic regression with adjustment for potential confounders

Population-based
Responsibility design
Logistic regression with adjustment for potential confounders

Main finding

As reported in the abstract

Adjusted odds ratio

0.86

95% CI 0.71–1.03

P = 0.11

Events by group

Precrash intervals6.4%212 of 3,299 events

Control intervals7.4%485 of 6,598 events

Precrash intervalsvs control intervals

aOR 0.86 (95% CI 0.71–1.03); P = 0.11

Observational data: associations, not effects.

Further findings

Crude proportion responsible

Outcome	Drivers with recent ICD implantation	Drivers without recent ICD implantation	← Lower odds with drivers with recent ICD implantation ←→ Higher odds with drivers with recent ICD implantation →	aOR (95% CI)	P value
Crash responsibility (all crash-involved drivers with determinate crash responsibility)	64%	51%	0.20.5125	2.20 (0.94–5.30)	P = 0.08
			0.20.5125Adjusted odds ratio (log scale)

Original publication

Cardioverter-Defibrillator Implantation as a Risk Factor For Motor Vehicle Crash. JACC Clin Electrophysiol. Published 29 January 2025. doi:10.1016/j.jacep.2024.12.002

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