In patients with arrhythmias, the most feared complication while driving is of driver incapacity resulting in a road traffic accident. Patients with implantable cardioverter-defibrillators (ICDs) may suffer incapacity as a result of device therapy itself. The aim of this review article was to examine the types of arrhythmia that occur while driving, the impact of arrhythmia on driving as well as evidence to support that driving itself can precipitate arrhythmias. We will also review the postulated mechanisms by which driving can precipitate arrhythmias. Finally, we will compare guidelines from the USA, Europe, and UK in fitness to drive in patients with arrhythmias and ICDs.