Driving Restrictions and Early Arrhythmias in Patients Receiving a Secondary Prevention Implantable Cardioverter-Defibrillator (DREAM-ICD-II study)

Background: Regulatory authorities of most industrialized countries recommend 6-months of private driving restriction after implantation of a secondary prevention ICD. These driving restrictions result in significant inconvenience and social implications. The purpose of this study was to assess the incidence rate of appropriate device therapies in contemporary recipients of a secondary prevention ICD. Methods: A retrospective study at three Canadian tertiary care centers enrolling consecutive patients with new secondary prevention ICD implants between 2016-2020. Results: 721 patients were followed for a median of 760 days (324, 1190). The risk of recurrent ventricular arrhythmia was highest during the first three months after device insertion (34.4%), and decreased over time (10.6% between 3−6 months, 11.7% between 6-12 months). The corresponding incidence rate per 100 patient-days was 0.48 (95% CI 0.35-0.64) at 90 days, 0.28 (95% CI 0.18−0.48) at 180 days and 0.20 (95% CI 0.13−0.31) between 181-365 days after ICD insertion (p<0.001). The cumulative incidence of arrhythmic syncope resulting in sudden cardiac incapacitation was 1.8% within the first 90 days and subsequently dropped to 0.4% between 91-180 days (p<0.001) after ICD insertion. Conclusions: The incidence rate of appropriate therapies resulting in sudden cardiac incapacitation in contemporary recipients of a secondary prevention ICD is much lower than previously reported, and significantly declines after the first three months. Lowering driving restrictions to three months after the index cardiac event seems safe and revision of existing guidelines recommending should be considered in countries still adhering to a 6-months period. Existing restrictions for private driving after implantation of a secondary prevention ICD should be reconsidered.

Spatial and Time Spillovers of Driving Restrictions: Causal Evidence from Limas Pico y Placa Policy

Driving restrictions are popular interventions in rapidly urbanizing developing countries. Their relatively inexpensive implementation appeals to the pressing need to reduce traffic congestion and pollution. Their effectiveness however, remains contested. Using high frequency data from the community-based driving directions app Waze, we evaluate the causal effect on traffic congestion of Lima's Pico y Placa driving restriction policy introduced in 2019. We find small improvements in traffic congestion for the policy's directly targeted areas. However, those improvements are offset by time and spatial spillovers in the opposite direction in the aggregate. Speed improved by 2 percent during the early weeks of the intervention, but this effect disappeared 16 weeks after the start of the policy. Moreover, traffic conditions worsened in adjacent areas and in hours outside the time schedule of the policy. In the aggregate, accounting for time and spatial spillovers, a simulation exercise suggests that overall welfare declined by 2 percent, mostly driven by the extensive margin (more roads becoming congested) outside the direct areas and hours targeted by the policy. The policy seems not only to have failed to achieve its intended benefits in terms of congestion, but also probably caused increases in traffic-related pollution. These results highlight the need for policy makers to take into account the overall impacts of driving restrictions policies before implementing them.

Driving restrictions following deep brain stimulation surgery

BackgroundThere are currently no Australian guidelines to assist clinicians performing deep brain stimulation (DBS) procedures in setting postoperative driving restrictions.PurposeWe aimed to provide recommendations for post-DBS driving restrictions to guide practice in Australia.MethodsA review of current Australian and international driving guidelines, literature regarding the adverse effects of DBS and literature regarding the long-term effect of neurostimulation on driving was conducted using Elton B Stephens Company discovery service-linked databases. Australian neurologists and neurosurgeons who perform DBS were surveyed to gain insight into existing practice.ResultsNo guidance on driving restrictions following DBS surgery was found, either in existing driving guidelines or in the literature. There was a wide difference seen in the rates of reported adverse effects from DBS surgery. The most serious adverse events (haemorrhage, seizure and neurological dysfunction) were uncommon. Longer term, there does not appear to be any adverse effect of DBS on driving ability. Survey of Australian practitioners revealed a universal acceptance of the need for and use of driving restrictions after DBS but significant heterogeneity in how return to driving is managed.ConclusionWe propose a 6-week driving restriction for private licences and 6-month driving restriction for commercial licences in uncomplicated DBS. We also highlight some of the potential pitfalls and pearls to assist clinicians to modify these recommendations where needed. Ultimately, we hope this will stimulate further examination of this issue in research and by regulatory bodies to provide more robust direction for practitioners performing DBS implantation.

Evaluating the impact of partial driving restrictions on local air quality in Chongqing using regression discontinuity design

Driving restriction is used to mitigate traffic congestion and improve air quality. A partial bridge restriction policy is created in Chongqing, China since the bridges are natural network bottlenecks due to the local river system. Is such a strategy really capable of reducing air pollution and further improving local air quality? Employing an integration of principal component analysis and a regression-discontinuity design approach, this study examines the short-run effect of the partial driving restrictions on the local air quality index in Chongqing, China. The examination is first conducted to the city level, and then its eight administrative districts are tested separately. The findings reveal that the air quality index of the whole city area has experienced deterioration after the introduction of restrictions in Chongqing. Among eight districts, Yuzhong is the only one experiencing an improvement of air quality index.