Doctor, am I allowed to drive? A practical case-based guide on fitness to drive in cardiovascular diseases adapted from the Swiss model
| 16 wrz 2023
O artykule
Article Category: Physicians Corner
Data publikacji: 16 wrz 2023
Zakres stron: 123 - 129
DOI: https://doi.org/10.2478/rjc-2023-0018
Słowa kluczowe
© 2023 Alexandru Achim, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fitness to drive with coronary heart disease [6].
| Group 1 | Group 2 | |
|---|---|---|
| ACS (conservative & PCI) | ✔ 1 week waiting period & not angina CCS IV | ✔ If
asymptomatic, EF >35%, normal exercise test 6-week waiting period |
| Elective PCI | ✔ | ✔ |
| Bypass | ✔ After recovery | ✔ If
NYHA I-II, EF >35%, normal exercise test 3-month waiting period |
| Stable coronary artery disease | ✔ No resting angina | ✔ If
asymptomatic, EF >35%, normal stress test annually |
Fitness to drive in the case of bradycardic arrhythmias [6].
| Group 1 | Group 2 | |
|---|---|---|
| AV Block I and Wenkebach II | ✔ | ✔ |
| AV Block Mobitz II
Paroxysmal in sleep While awake |
✔ | ✔ |
| ✔ After PM implantation | ✔ After PM implantation | |
| AV Block III born | ✔ If asymptomatic | ✔ After PM implantation |
| AV Block III acquired | ✔ After PM implantation | ✔ After PM implantation |
| RBBB or isolated hemiblock | ✔ | ✔ |
| LBBB | ✔ | ✔ After echocardiography |
| Bifascicular block with normal PQ interval | ✔ | ✔ |
| Bifascicular blocked with prolonged PQ interval | ✔ If asymptomatic | ✔ If asymptomatic |
Ion channel anomalies [6].
| Group 1 | Group 2 | |
|---|---|---|
| Congenital long QT | ✔ If ICD* | Case-by-case assessment ✘ If ICD is indicated |
| Brugada syndrome | ✔ If ICD* | Case-by-case assessment ✘ If ICD is indicated |
Congenital and hypertrophic diseases [6].
| Group 1 | Group 2 | |
|---|---|---|
| Congenital diseases
Asymptomatic Symptomatic |
✔ | ✔ |
| Case-by-case assessment | Case-by-case assessment | |
| Hypertrophic cardiomyopathies
Asymptomatic Symptomatic |
✔ |
✔ If no ICD indicated |
Fitness to drive with syncope [6]
| Group 1 | Group 2 | |
|---|---|---|
| Vasovagal syncope
1×, not sitting/driving >1× OR while sitting/driving |
✔ | ✔ |
| ✔ 1-month waiting period | ✔ >3-month waiting period and case-by-case assessment | |
| Triggering and recoverable factor | ✔ | ✔ |
| Unclear syncope without prodrome | ✔ 3-month waiting period | ✔ If diagnosis and treatment; Otherwise, 12-month waiting period |
Fitness to drive with supraventricular arrhythmias [6]. Relevant symptoms = severe dizziness, presyncope, syncope. Regular: AVNRT, atrial flutter, atrial tachycardias. Effective therapy: medicinal, interventional, cardiac pacemaker.
| Group 1 | Group 2 | |
|---|---|---|
| Regular SV tachycardia
Without relevant symptoms With relevant symptoms |
✔ | ✔ |
| ✔ After ablation, 4 weeks of waiting and cardiological control | ✔ After ablation, 4 weeks of waiting and cardiological control | |
| WPW No history of tachycardia | ✔ | ✔ |
| Atrial fibrilation
Without relevant symptoms With relevant symptoms |
✔ | ✔ |
| ✔ After therapy, 4 weeks of waiting and cardiological control | ✔ After therapy, 4 weeks of waiting, and cardiological control |
Devices: After PM/ICD implantation or replacement [6].
| Group 1 | Group 2 | |
|---|---|---|
| PM: with history syncope | ✔ 1 week waiting period | ✔ 3-month waiting period and cardiological control |
| PM: without history of syncope | ✔ 1 week waiting period | ✔ 4-week waiting period and cardiological control |
| ICD | ✔ With restrictions | ✘ |
| CRT-D in non-ischemic cardiomyopathy & for primary prevention | ✔ 1 week waiting period | ✔ If:
>6 months sustained improvement to EF >50% and D function deactivated |
| One-time, adequate shock | ✔ 3 months waiting period | |
| Inappropriate shock | ✔ When cause resolved | |
| Antitachycardic pacing of ventricular tachycardia with relevant symptoms without relevant symptoms | ✔ 3-month waiting period | |
| ✔ | ||
Fitness to drive with heart failure [6].
| Group 1 | Group 2 | |
|---|---|---|
| NYHA I and II | ✔ | ✔ If EF >35% and normal stress test |
| NYHA III | ✔ If stable | ✘ |
| NYHA IV | ✘ | ✘ |
| LVAD | Case-by-case assessment | ✘ |
| After heart transplant | ✔ After recovery | ✔ NYHA I/II, EF >35% & normal stress test and 3-month waiting period |
Ventricular arrhythmias: normal and structural heart disease [6]. Symptoms: severe vertigo, presyncope, syncope; therapy: drug or ablation or ICD.
| Ventricular arrhythmias: no structural heart disease, no ion channel disease (typically from RVOT or LVOT) | ||
|---|---|---|
| PVC | ✔ | ✔ |
| NSVT and VT
without relevant symptoms with relevant symptoms |
✔ | Case-by-case assessment |
| ✔ After therapy, 4 weeks of waiting and cardiological control | ✔ After therapy, 4 weeks of waiting and cardiological control | |
| Idiopathic ventricular fibrillation | ✔ After ICD | ✘ |
| PVC | ✔ | ✔ |
| NSVT
Without relevant symptoms With relevant symptoms |
✔ | Case-by-case assessment |
| ✔ After therapy, 3-month wait and cardiological control | ✘ | |
| Sustained VT with/without symptoms | ✔ After ICD | ✘ |
Miscellaneous [6].
| Group 1 | Group 2 | |
|---|---|---|
| Arterial hypertension | ✔ Without cerebral symptoms or visual disturbances | ✔ Without cerebral symptoms or visual disturbances BP <180 mmHg systolic / <110 mmHg diastolic |
| Pulmonary hypertension | ✔ If NYHA I-III | ✔ If NYHA I-II & no permanent O2 need |
| Thoracic aortic aneurysm | ✔ If <6.5 cm | ✔ If <5.5cm |
Valvular disease [6].
| Group 1 | Group 2 | |
|---|---|---|
| Aortic Stenosis Asymptomatic Symptomatic After treatment | ✔ |
✔If not severe, annual reevaluation |
| Other valvulopathies Asymptomatic Symptomatic After treatment | ✔ |
✔EF >35% and no severe mitral stenosis |