A set of keys to one’s first car is an unrivalled symbol of personal autonomy and liberation. The elation a teenager feels when getting the car keys for the first time (now more likely to be fobs, phones or fingerprints) is only equaled in intensity by the crushing defeat of being stripped of this privilege when, say, curfew is broken. For people with medical problems, relinquishing one’s driving privileges, in this case for reasons of health and safety, is a difficult, often contentious and life-changing affair. Every year, those who receive implantable cardioverter/defibrillators (ICDs) are told to hand over the keys in varying degrees depending on the country or state in which they live. This not only impacts the life of the ‘grounded’ patient but also the friends and family around them.

In this issue of Heart, Staples and co-workers1 challenge previously held beliefs regarding fitness to drive post-ICD implantation. In a population-based retrospective cohort study spanning 22 years (1997–2019), publicly funded universal health insurance data and cardiac device registries in British Columbia were to identify patients with ICD implants. These were cross-referenced with driving data to examine crash risk within the first 6 months post-device implantation. Individuals with a first ICD implantation, for either primary or secondary prevention, were matched to three controls. In the event of an accident, baseline driving history was established using a 3-year lookback interval. Furthermore, traffic contraventions were examined …