The Automobile Association of Quebec does not have a precise policy for the conduction of a car or truck for people with a defibrillator within Quebec. The association follows the Canadian recommendations that were reviewed in 2003 and published in 2004. (Reference: Société canadienne de cardiologie www.ccs.ca under the heading conference consensus 2003: Assessment of the Cardiac Patient for Fitness to Drive and Fly)

In Quebec, the doctor must advise patients if they can or cannot drive a motor vehicle using the recommendations made by the Canadian Cardiology Association. This is not an obligation (the doctor is not required to notify the Quebec Automobile Association). However, the patient should follow the advice of their doctor.

As for commercial driving (trucks, public transportation vehicles (i.e. bus, mini bus, taxi etc.) (i.e. class 1 driving permit) the rules are simple. All patients with an implantable cardioverter defibrillator should lose their class 1 driving permit. It must be understood that this is a necessary precaution both for the driver as well as other drivers on the road. Many of these drivers suffer from cardiac insufficiency anyway, and cannot drive a truck with regards to the recommendations made by the Canadian Cardiology Association (which states that all patients with a NYHA 3 or 4 of 4 cannot drive a truck).

With regards to private drivers the situation is a little bit more complex. In fact, we must divide patients with an implantable cardioverter defibrillator into 2 large groups: primary prevention and secondary prevention. 

Primary prevention corresponds to patients who have had an implantable cardioverter defibrillator to prevent a serious arrhythmia and have never presented with this condition (normally this includes patients with cardiac insufficiency). For these patients it is prohibited to drive for a period of 4 weeks following the installation of their defibrillator. After this time, provided the patient has not received a shock form the defibrillator, the patient may start driving without restrictions. For patients who were implanted for reasons of secondary prevention (serious ventricular arrhythmia) driving is normally prohibited for a period of 6 months following the arrhythmia. However, if dizziness or loss of consciousness does not accompany the serious ventricular arrhythmia, the patient will be prohibited to drive for a period of just 3 three months. 

Once the initial driving restrictions have been made (after the installation of a defibrillator) there may be other periods of restriction. For example, if a patient receives an appropriate shock from the defibrillator or if there is a rapid stimulation from the cardiostimulator to stop an episode of ventricular tachycardia that has caused dizziness, the driving permit will be suspended for a period of 6 months following this arrhythmia episode. All of this may appear complicated but, once again, we must understand that these recommendations are in place for the security of the patient, their family and other drivers on the road. It is important to discuss this with your doctor (electrophysiologist) and with the personnel of the various defibrillator clinics where your follow up visits are done.