Driving Guidelines and Restrictions in Patients With a History of Cardiac Arrhythmias,Syncope,or Implantable Devices |
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Authors: | Dan Sorajja Win-Kuang Shen |
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Institution: | 1.Division of Cardiovascular Diseases,Mayo Clinic,Rochester,USA |
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Abstract: | The need to drive is universal in many countries. Patients with syncope, cardiac arrhythmias, or implantable cardioverter–defibrillators
(ICDs) have an ongoing risk of sudden incapacitation that may cause harm to themselves and/or others when driving. Restrictions
on driving and driving guidelines have been developed with the intent to reduce and prevent motor vehicle accidents, thereby
improving personal and public safety. Several guidelines and consensus statements recently were updated. This review focuses
on the syncope-related driving guidelines and restrictions. Driving issues related to other causes of loss of consciousness,
such as drug or alcohol intoxication, epilepsy, or metabolic disorders, are not included in this review. Approximately 1%
to 3% of all motor vehicle accidents are caused by the driver’s sudden incapacitation; of these accidents, 5% to 10% are related
to cardiac causes, with or without syncope. Major cardiac causes of syncope are neurally mediated mechanisms, bradycardia,
and tachycardia. When the cause of syncope is determined and adequately treated, no driving restrictions are usually required
after treatment is implemented. Patients who receive ICD therapy for primary or secondary sudden cardiac death prevention
are at risk for future device discharges and sudden incapacitation whether or not they are driving. When the cause of syncope
is unknown, the response to treatment is uncertain (such as treating the neurocardiogenic/vasovagal syncope), or ICD discharge
is possible, driving recommendations are based on the estimation of “risk of harm while driving” and the general consensus
on the threshold of “acceptable risk of harm.” The annual risk of harm while driving can be estimated by the following formula:
driving time (%) × vehicle type (commercial to private) × annual risk of syncope or incapacitation × probability of injury
or accident. |
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