Driving post CRT D procedure

Driving

by Tracey_E - 2020-11-05 22:01:30

Where did you get 6 months? I believe 1 month is standard in UK. It may vary if you've passed out. 

I attach UK Govt link

by Gemita - 2020-11-06 04:28:18

Hello Sandoval,

https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive

It is complicated since it may be assessed on arrhythmia type (Ventricular as opposed to an Atrial arrhythmia for instance) and any symptoms you are getting or have had recently (like syncope, dizzy spells).  You may want to read UK Govt link above if you haven't already, and then contact driver vehicle licensing agency (DVLA) for guidance from their medical team.  I would first though advise getting a support letter from your pacemaker team or your GP confirming at the earliest the reason for your CRT-D.  The more help you can get, the better, to support your early fitness to drive once the CRT-D device is fitted. 

From your comments, it sounds to me as though you might need to have that meaningful conversation with your doctors anyway not just about your ability to resume driving after implant but also about the reason why you are actually getting a "Defibrillator"?  CRT (cardiac resynchronisation therapy) hopefully will help improve your EF (ejection fraction) and restore synchrony between both ventricles, but I am assuming that your doctors feel a defibrillator may also be needed to protect you, so I would want to be clear about the exact reason for the Defibrillator?  Hopefully the Atrial Flutter has been successfully stopped but an ablation is no guarantee unfortunately that you will remain arrhythmia free, or that you will not develop other arrhythmias, including ventricular arrhythmias in the future.  

I hope everything turns out well for you and that you can continue to safely drive

Driving post CRT D procedure

by sandoval - 2020-11-06 07:14:17

Thanks for link Gemita but the CRT section mentions a week so its very confusing. My GP didn't even know what an electrophysiologist was so I rely mainly on Dr Google for info. Surely using public transport would be more dangerous as far as keeping my arm down because you have to hold onto rails to avoid falling over, at least here in London anyway. It seems docs have tunnel vision and are only concerned with what happens in hospital but that is only a few hours whereas outside is years (hopefully)

Driving

by WazzA - 2020-11-06 07:20:04

I voluntarily surrendered  my driving licence prior to having an ablation & a pacemaker fitted, I was close to passing out at times & really did NOT want to risk injuring family, other road users or pedestrians nor myself. 

I applied for my licence back through DVLA medical dept after my ablation & I was given the all clear by my Cardio . I didn't drive for 6 months in all , Yes it was very hard relying on others to help out but got through it all. After my PM was implanted I had to stop for just a week while things healed & settled down again .

I've had zero episodes for well over a year now & see no reason why that will not continue. 

Best wishes.

In an ideal world

by Gemita - 2020-11-06 07:40:00

Sandoval,

You are so right, in an ideal world the GP would be in touch with the pacemaker team and be fully in the picture, but this doesn't always happen, does it.  And my doctors don't like having to do administrative tasks like writing supporting letters for the DVLA, but it may be necessary.  You may still need to speak to your EP/pacemaker team therefore and get a supporting letter to accompany any application if you have to reapply for a driving licence.  

I am unclear though whether you will need to "reapply" if you are still driving at present and haven't surrendered your licence?  Maybe you will just need to refrain from driving for a limited period after CRT-D, and provide confirmation to DVLA of your condition/fitness to drive when your doctors confirm all is well.  The DVLA would need to know the reason for the Defibrillator and whether the health condition requiring the Defibrillator is being well controlled?   Only your EP/Cardiologist/GP can provide evidence of your condition and confirm how it affects you.  Any supporting letter should confirm this.

I agree, getting around in London by public transport is not easy, but driving in London would be even more dangerous if you passed out.  Like Wazza I also surrendered my licence prior to getting a pacemaker and have now sadly surrendered it permanently because I lost complete confidence in my ability to safely drive.   

Fitness to Drive

by Selwyn - 2020-11-06 16:18:26

My experience of the DVLA  is that they are very inflexible with regard to changing their opinion as to when and if you can drive. A GP letter is of little use. Maybe a consultant letter would be best. They are not likely to change the rules for you unless there has been supplied misinformation. I have written many letters to the DVLA on behalf of professional drivers etc. I have never known. them to change their mind. Their concern is not for your safety but the safety of the public. One very nice gentleman I knew was decapitated when he collapsed at the wheel of his car, crashing on the motorway.  

You have a legal duty to inform the DVLA  of any change in your health that could affect your driving. 

Don't blame your GP for not knowing what an electrophysiologist is as it is not a term used around  general practice in the UK, rather the word is about 'pacemaker technicians' or 'consultant cardiologists.'  

You are mistaken when you say your CRT-D is only for resynchonisation. The D variety is only fitted if there is a risk of needing ventricular defibrillation.  You need to understand why ( if you are willing to accept the answer). The defibrillation need is nothing to do with your atrial flutter ablation ( and I have had two for  atrial flutter- pleased to hear that yours was successful first time round).

I note you say, "I rely on a car for exercise - gym/golf etc and shopping and I am the family taxi, visiting friends , days out etc etc."  If we take the worse scenario and you have a driving ban, apart from taking the excellent public transport in London ( which has just secured £1.8 billion of funding from the Government, due to Covid ), or taxis, you could invest in a bicycle (or electric bike)  and get your exercise in the process of travelling. Gyms remain closed due to Covid risk at present. Shopping is best on-line if you want to avoid Covid - you are in a vulnerable group. Certainly, when I couldn't drive due to my PM I cycled, appreciating that the risk was to myself rather than taking other people to their deaths. 

Quality of life is how you see yourself. Whilst going to the gym and playing golf are important at present, this may be a challange to you to find other activities that also add quality to life. Should you  continue to struggle, then some Cognative Behavioural Therapy may of help.I can certainly think of many people who would envy the assets you have with regard to your activity. 

I have swapped swimming for cycling during Covid. My car remains in the garage. I am enjoying the fresh air and benefit of seeing a little more of my area at a speed I can appreciate the surrounds. I count myself fortunate to be able to do so. Sure, life may have limitations, however the barriers are mainly in the mind - tell a blind person you will never play football, and the next thing you know is they are playing with a bell in the ball. Try to get somethijng positive out of your change of circumstances.

Driving post CRT D procedure

by sandoval - 2020-11-06 17:00:42

I get the concern about passing out while driving but I've never passed out in my life so I don't see why I would start now. Without golf & gym etc I would have no social life so not much point having a CRT D . I've not had any episodes of arrythmias since an ablation in March so the Defibrillator seems more of a "just in case" which may never happen. There is no family to help me if I lose my independance. Seems the choice is pacemaker or social life. I think docs should consider quality of life , not just life.

CRT-D Procedure

by Gemita - 2020-11-06 17:57:26

Sandoval,

A pacemaker should help you to live a better quality of life, to enjoy fully all your activities, not the opposite.

I am unclear why you need the defibrillator which is why I suggested you go back and speak with your doctors and make sure they clearly tell you.  For example have they seen another arrhythmia, more worrying than the atrial flutter which might need to be stopped, or is your defibrillator only being implanted as you say "just in case" ?as a safety net in case your heart stops?   I certainly wouldn't want a defibrillator unless it was absolutely necessary, although I doubt it would have been offered if hadn't been necessary.

Good luck as you move forward

CRT-D, flutter, and ablation

by AgentX86 - 2020-11-06 18:37:16

The rules are obviously different in the UK than here in the states.  Each state is somewhat different but generally there are no driving restrictions  unless one has lost consiousness.  Then, if the condition that cause the loss is corrected, there is no suspension of driving priveleges. 

A year ago I had a seizure. No cause was found so there was no guarantee that it wouldn't happen agina, though drugs could help (not guaranteed). The rule here is that "one's free".  You're not considered epileptic until your second, so reportiong to DMV was optional.  He didn't but advised me not to drive for the six months anyway.  After thinking about it, I didn't want to kill anyone (me included) and putting everything I've worked for at risk (we love our lawyers) was just stupid.  My wife drove me too and from work each day (~40mi/1hr round trip) and everywhere else I needed to go.

I also had flutter and three ablations.  Aflutter isn't generally a big deal so there were no restrictions for that.  My doctors didn't want me to drive for a week after the ablations but that had little to do with liability.  Even after my CABG surgery, it was only seven weeks until I was cleared to drive. Again, that was a medical thing and the DMV was never notified.

I had a near-syncope event (and several, I assume, while sleeping) before my PM implant (nothing to do with flutter).   Because I was getting a PM anyway, I had an AV ablation to stop the flutter symptoms. Again, only a month medical driving restriction (no DMV notification).

I was given a CRT-P.  There was no reason for a CRT-D, so I'd look for a reason that you needed the defibrillator.  As others have said, the defibrillator isn't used for atrial arrhythmias, rather dangerous ventricular arrhythmias (V-Tach and V-Fib, generally).

Driving post CRT D procedure

by sandoval - 2020-11-06 21:22:46

Thanks for the responses. I remember at the consultation the junior EP looking at the pc screen saying I had 4 stents previously fitted when I had never had any stents so it makes you wonder what they do know.

Obviously I need another appointment which wouldn't be necessary if I had more than a few minutes for the first one. It seems a CRT P would be my best option but that was never discussed.I got the impression that CRT D was standard procedure (NHS system is very much like a conveyor belt) but if it means losing my quality of life & independance which the docs would know nothing about since they don't know me then I'll have to cancel.

CRT-D

by AgentX86 - 2020-11-06 23:37:16

I wouldn''t cancel.  If you need a pacemaker, well, you need a pacemaker.  I would certainly get them to educate you befor consenting to surgery.

Yes, I would ask for a further appointment to discuss this with your doctors

by Gemita - 2020-11-07 03:43:18

Sandoval,

We are all trying to help, not to push you into one direction or the other.  As I mentioned, I would go back to see them or get a telephone consultation with your consultant before you go ahead with surgery and make sure that you understand why a CRT-D is really required or alternatively ask whether a CRT-P could be an option?  

Please feel free to private message me if you need help.  I am not so many miles away from you.  If you go back to see them, try to take someone with you.  Yes as AgentX86 says, I wouldn't cancel implant procedure.  I would though ask about the option of a CRT-pacemaker instead of a CRT-defibrillator or why they have recommended a CRT-D specifically.  I note from an earlier post that you do not think your implant procedure will happen any time soon due COVID-19 so you probably have time to get a second opinion from another hospital or consultant in the same hospital if you need to. We have come a long way from talking about fitness to drive but hope it has helped clear some of the fog.  

Update Sandoval, hopefully not the case, but when you do go back to see your consultant, make absolutely sure you ask them to check that your records are really your records.  Your comments about them saying "I see you have had four stents" would concern me and make me question the validity of your records or whether your doctor was looking at another patient's records?  It happened to my husband.  We were called in and greeted "Hello Michael, good news your biopsy results were absolutely clear", to which we replied, "we haven't had a biopsy".  The consultant was looking at the wrong patient's records and we were asked to leave the room while he sorted himself out !  It can and does happen unfortunately

Reason

by ROBO Pop - 2020-11-07 14:34:16

Doesn't matter to me, his team says he needs a CRT-D then so be it. What's really important in this discussion are the innocent lives he puts at risk by driving. That's why the UK has those rules. Boo whoo, it's inconvenient for him, well how inconvenient would it be if he took someone's life or cause debilitating injury due to selfishness. As someone said there's excellent transportation options available...use them. Like others here, I gave up driving altogether for the safety if others. Think of others

Never passed out, but ....

by LondonAndy - 2020-11-07 19:31:02

I realise the temporary disruption to your life will be a pain, but you know you are going to have to go through this at some point.  It's not like the NHS goes around looking to implant expensive devices for fun, and I agree with Selwyn - you won't get DVLA to make an exception for you.

Gyms and golf courses are closed due to national Covid restrictions, I'm not sure what shopping can't be done online, and you don't need to stand up on a bus - capacity is extra restricted for social distancing rules, so you will get a seat.  So to me, now seems like a good time to have it done and be fully ok to do everything come the decent weather returning next year.

How to use the NHS

by Selwyn - 2020-11-08 11:06:22

Dear Sandoval,

I am very sorry to hear of the apparent poor communication with yourself from your health advisors. 

The NHS is not like a conveyor. As a patient you, yes YOU,  have some responsibility and rights. For instance, if you don't like the planned procedure, you have the right to decline this. You can ask questions of your health advisors. You should expect infomed consent for the procedure and your questions answered. Don't blame the doctors :"Seems the choice is pacemaker or social life. I think docs should consider quality of life , not just life.". The considerations are yours, not your doctors,  as you know yourself best.  Whilst I appreciate when receiving bad news, there is a tendency to lash out, it is up to yourself to evaluate the advice offered. Likewise, you need to understand the need for a defibrillator, if you are prepared for the answer - and not everyone is!  As an autonomous adult, if you require further information, seek it. You have available to yourself a GP who can help, you have specialised cardiac nurses, and hospital doctors, all at no cost to you financially.  You can enable yourself whilst Covid restrictions exist on your gym, golf, and socialising with others ( as are the restrictiions on us all in the UK at present), perhaps you can be finding  the time to pick up the telephone and get some information to make up your mind as to whether you want the offered procedure with all its advantages and disadvantages?

For your further information your rights NHS Patient Charter: http://www.tgmeds.org.uk/patientscharter.html

I would advise any of our friends from outside of the UK to view the NHS Patient Charter. We are very fortunate in the UK.