2. Driving: Cardiac Rhythm, Arrhythmia Device and Procedures
Ventricular Arrhythmias
VF (no reversible cause)
- Private driving is permitted beginning 6 months after the event has occured.
- Commercial driving is not permitted (disqualified).
Hemodynamically unstable VT
- Private driving is permitted beginning 6 months after the event has occured.
- Commercial driving is not permitted (disqualified).
VT or VF due to reversible cause*
- Private driving is not permitted until successful treatment of underlying condition has occurred.
- Commercial driving is not permitted until successful treatment of underlying condition has occurred.
Sustained VT with no associated impairment of consciousness; LVEF<30%
- Private driving is permitted beginning 3 months after the event has occured AND satisfactory control has been achieved.
- Commercial driving is not permitted (disqualified).
Sustained VT with no associated impairment of consciousness; LVEF≥30%; ICD has not been recommended
- Private driving is permitted beginning 4 weeks after the event has occured AND satisfactory control has been achieved.
- Commercial driving is permitted beginning 3 months after the event has occured AND satisfactory control has been achieved.
Nonsustained VT with no associated impairment of consciousness
- Private driving is permitted no restriction.
- Commercial driving is permitted no restriction.
*Examples include, but are not limited to, ventricular fibrillation (VF) within 24 hrs of myocardial infarction, VF during coronary angiography, VF with electroncution and VF secondary to drug toxicity. Reversible-cause VF recommendations overrule the VF recommendations if the reversible cause is treated successfully and the VF does not recur.
Paroxysmal Supraventricular Tachycardia, Atrial Fibrilation or Flutter
With impaired level of conciousness
- Private driving is permitted if satisfactory control has been achieved.
- Commercial driving is permitted if satisfactory control has been achieved.
Without impaired level of conciousness
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
N.B. Drivers should receive chronic anticoagulation is clinically indicated (i.e. in the presense of atrial fibrillation or atrial flutter).
Persistent or Permanent Atrial Fibrillation or Atrial Flutter
Adequate ventricular rate control; no impaired level of consciousness
- Private driving is permitted with no restriction AND drivers should receive chronic anticoagulation if clinically indicated.
- Commercial driving is permitted with no restriction AND drivers should receive chronic anticoagulation if clinically indicated.
Sinus Node Dysfunction
No associated symptoms
- Private driving is permitted with no restriction AND drivers should receive chronic anticoagulation if clinically indicated.
- Commercial driving is permitted with no restriction AND drivers should receive chronic anticoagulation if clinically indicated.
Sinus Node Dysfunction
No associated symptoms
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
Associated symptoms (sick sinus syndrome)
- Private driving is not permitted until successful treatment has occured.
- Commercial driving is not permitted until successful treatment has occured.
Atrioventricular (AV) and Intraventricular Block
Isolated first degree AV block
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
Isolated right bundle branch block (RBBB)
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
Isolated left anterior fascicular block
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
Isolated left posterior fascicular block
- Private driving is permitted with no restriction.
- Commercial driving is permitted with no restriction.
Left bundle branch block (LBBB)
- Private driving is permitted if no associated impairment of level of consciousness is present.
- Commercial driving is permitted if no associated impairment of level of conciousness is present AND no higher grade AV block on an annual 24-hour Holter.
Bifascicular block
- Private driving is permitted if no associated impairment of level of consciousness is present.
- Commercial driving is permitted if no associated impairment of level of conciousness is present AND no higher grade AV block on an annual 24-hour Holter.
Second-degree AV block; Mobitz I
- Private driving is permitted if no associated impairment of level of consciousness is present.
- Commercial driving is permitted if no associated impairment of level of conciousness is present AND no higher grade AV block on an annual 24-hour Holter.
First-degree AV block + bifascicular block
- Private driving is permitted if no associated impairment of level of consciousness is present.
- Commercial driving is permitted if no associated impairment of level of conciousness is present AND no higher grade AV block on an annual 24-hour Holter.
Second-degree AV block; Mobitz II (distal AV block)
- Private driving is not permitted (disqualified).
- Commercial driving is not permitted (disqualified).
Alternating LBBB and RBBB
- Private driving is not permitted (disqualified).
- Commercial driving is not permitted (disqualified).
Acquired third-degree AV block
- Private driving is not permitted (disqualified).
- Commercial driving is not permitted (disqualified).
Congenital third-degree AV block
- Private driving is permitted if no associated impairment of level of consciousness is present.
- Commercial driving is permitted if no associated impairment of level of consciousness is present, QRS duration ≤ 110 msec, AND no documented paused ≥ 3 seconds on an annual 24-hour Holter.
If a permanent pacemaker is implanted, the recommendations in the permanent pacemaker section prevail.
Permanent Pacemakers
All patients
- Private driving is permitted only after a 1 week waiting period, with no impaired level of consciousness after implant, with normal sensing and capture on ECG, AND no evidence of pacemaker malfunction at regular pacemaker clinic checks.
- Commercial driving is permitted only after a 1 month waiting period, with no impaired level of consciousness after implant, with normal sensing and capture on ECG, AND no evidence of pacemaker malfunction at regular pacemaker clinic checks.
Implantable Cardioverter Defibrillators (ICDs)
Primary prophylaxis, NYHA Class I-III
- Private driving is permitted beginning 4 weeks after implant.
- Commercial driving is not permitted (disqualified)**.
A primary prophylaxis ICD has been recommended but declined by the patient
- Private driving is permitted with no restriction.
- Commercial driving is not permitted (disqualified)**.
Secondary prophylaxis for VF or VT with decreased level of conciousness; NYHA Class I-III
- Private driving is permitted beginning 6 months after the event has occured*.
- Commercial driving is not permitted (disqualified)**.
Secondary prophylaxis for sustained VT with no associated cerebral ischemia; NYHA Class I-III
- Private driving is permitted beginning 1 week post implant, in addition to the appropriate waiting period for the VT (see Ventricular Arrhythmias).
- Commercial driving is not permitted (disqualified)**.
Any event resulting in device therapies being delivered (shock or ATP), in which level of conciousness was impaired, or the therapy(ies) delivered by the device was/were disabling
- Private driving is permitted following 6 months restriction.
- Commercial driving is not permitted (disqualified)**.
*The 6 month period begins not at the time of ICD implant, but rather at the time of the last documented episode of sustained symptomatic ventricular tachycardia (VT), or syncope judged to be likely due to VT or cardiac arrest. For patients who have a bradycardia indication for pacing as well, the additional criteria under the permanent pacemaker section also apply. All patients must be followed from a technical standpoint in a device clinic with appropriate expertise.
**ICDs may sometimes be implanted in low-risk patients. Individual cases may be made for allowing a commercial driver to continue driving with an ICD provided the annual risk of sudden incapacitation is believed to be 1% or less.
Other
Brugada’s syndrome; Long QT syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
- Private driving is permitted after appropriate investigation and treatment guided by a cardiologist and beginning 6 months after any event causing impaired level of conciousness.
- Commercial driving is not permitted (disqualified)*.
Catheter ablation procedure; EPS with no inducible sustained ventricular arrhythmias
- Private driving is permitted beginning 48 hours after discharge.
- Commercial driving is permitted beginning 1 week after discharge.
*Inherited heart diseases may sometimes be indentified to pose a very low risk to patients. Individual cases can sometimes be made to allow a commercial driver to continue driving despite the diagnosis of one of these diseases, provided the annual risk of sudden incapacitation is believed to be 1% or less.