One hundred one patients who received an implantable automatic cardioverter defibrillator (ACD) were evaluated to determine the reemployment rate and factors associated with return to work. Forty-seven were employed before ACD implantation. Their mean (+/- standard deviation) age was 53 +/- 11 years, 83% were men, 75% had coronary artery disease, 76% presented with cardiac arrest and 28% had concomitant cardiac surgery. The mean ejection fraction of these patients was 0.41 +/- 0.15. At follow-up, 29 patients (62%) had resumed work at 11 +/- 9 weeks after implantation. Those who returned to work were better educated (15 vs 11 years, p less than 0.001) and less likely to have a history of prior myocardial infarction (p less than 0.05). There were no significant differences between patients who returned to work and those who did not in terms of age, sex, race, functional class, ejection fraction, extent of coronary artery disease, reason for ACD, or concomitant surgery. Multivariate analysis revealed that level of education was the single best predictor of reemployment status. The only other factors found to add significant predictive power in a stepwise analysis were extent of coronary artery disease and marital status. The model using these 3 variables had a sensitivity of 83% and a specificity of 72%. It was concluded that (1) most patients employed before ACD implantation are able to return to work after the procedure, and (2) nonmedical factors play an important role in the resumption of work-related activities. These findings have important quality-of-life and cost-effectiveness implications for ACD implantees.