Driving recommendations for patients (pts) with an implantable cardioverter defibrillator (ICD) vary widely and no general guidelines are available. We studied the follow-up of 291 pts who have been followed for a mean of 38 +/- 26 months after ICD implant. The driving behaviour prior to and after ICD implant was evaluated using 25 questions. Results: 105 pts (36%) stopped driving at the time of ICD implant (group 1), whereas continuous driving was observed in 186 pts (64%) (group 2). No death occurred during driving. Accidents (AC) occurred in 13 pts (7%) in group 2; but did not relate to any ICD-discharges (D). AC were caused by own fault in 1 pt and by third party in 12 pts. ICD discharges occurred in 84 pts (80%) in group 1 and in 153 pts (81%) in group 2 with a mean number of 18 +/- 26 ICD-D/pt in group 1 and 12 +/- 20 ICD-D in group 2 (p = ns). ICD-D during driving occurred in 11 pts (6%), in 2 pts within 12 months and in the remaining 9 pts > 12 months.Conclusions: Accidents among ICD recipients or ICD-D during driving occur rarely. Most of ICD-D during driving occurred late, after ICD implant, and were not followed by accidents. Therefore, it seems that driving can be safely permitted after ICD implantation without any restrictions.