Should I limit my driving if I have a heart arrhythmia?

If you have an arrhythmia that does not cause significant symptoms, you do not have to stop or limit driving. But those people with arrhythmias that cause confusion, dizziness, lightheadedness, or loss of consciousness may not be allowed to drive-at least temporarily-because of the risk of an accident.

Restrictions on the right to drive depend on several factors, including:

• Arrhythmias that cause unconsciousness.
• The cause of the arrhythmia.
• The likelihood that the arrhythmia will recur.
• The likelihood that a recurrent arrhythmia will cause symptoms.
• Whether your ICD (implantable cardioverter defibrillator) has given you a therapeutic shock.
• The laws of your state.

Talk to your doctor about whether you should restrict your driving. Your doctor will assess your medical history and your risk of having another arrhythmia that could lower your ability to drive safely. To help doctors with this decision, the American Heart Association and the Heart Rhythm Society recommend the following driving restrictions:^{1, 2}

• Most people with arrhythmias that do not cause symptoms usually need no limitations on driving.
• People whose arrhythmias have caused (or have the potential to cause) impairment of consciousness should not drive until:
  • The arrhythmia has been cured by surgery or ablation techniques.
  • The cause of the arrhythmia has been identified and corrected.
• If you get an ICD because you are at risk for a life-threatening arrhythmia (but have never had one), you should not drive for at least 1 week afterward to allow time to heal. After you heal, you can drive again as long as your ICD has never given you a shock and you have no symptoms of an arrhythmia. But keep in mind that an arrhythmia could cause you to pass out (lose consciousness).
• If you get an ICD because you have already had a life-threatening arrhythmia, you should wait at least 6 months before you drive again.
• If you have an ICD that has given you a shock for an arrhythmia, you should wait at least 6 months before you drive again.

Many states have passed laws to temporarily suspend or permanently revoke the licenses of people who have a high risk of arrhythmias that could make them unconscious. This is also true for people who fly airplanes.

Suggestions for specific arrhythmias vary depending on whether you drive a private vehicle or a commercial vehicle and can be summarized as follows.

• Ventricular fibrillation: You may drive a private vehicle if the arrhythmia has not recurred after 6 months of treatment. Do not drive commercial vehicles.
• Ventricular tachycardia (VT): You may drive a private vehicle if the arrhythmia has not recurred after 3 to 6 months of treatment. If the VT was short-lasting (nonsustained), you can drive a commercial vehicle if the arrhythmia has not recurred after 6 months of treatment. If the VT was long-lasting (sustained), in general, you cannot ever drive commercial vehicles.
• Supraventricular tachycardias: You may drive if the arrhythmia does not cause symptoms. You may drive if the arrhythmia was treated (and either cured or controlled) and has not recurred. Do not drive if the arrhythmia is not controlled.
• Bradycardia or bradyarrhythmia: You may drive if the arrhythmia does not cause symptoms. Do not drive if the arrhythmia causes impairment of consciousness and you have not had a pacemaker implanted. You can drive if you have a pacemaker, usually 1 to 4 weeks after the pacemaker is implanted.
• Other forms of syncope (vasovagal syncope, carotid sinus sensitivity): Driving limitations depend on the predictability and frequency of the syncope.

Citations

1. Epstein AE, et al. (1996). Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations. A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Circulation, 94(5): 1147–1166.

2. Epstein AE, et al. (2007). Addendum to Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations: A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Public safety issues in patients with implantable defibrillators A scientific statement from the American Heart Association and the Heart Rhythm Society. Circulation, 115(9): 1170–1176.