Driving guidelines and restrictions in patients with a history of cardiac arrhythmias, syncope,or implantable devices

Dan Sorajja, Win Kuang Shen

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)443-456
Number of pages14
JournalCurrent Treatment Options in Cardiovascular Medicine
Issue number5
StatePublished - Oct 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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