Section 2: Cardiovascular Diseases

1. Unstable coronary syndrome (unstable angina or myocardial infarction)

2. Cardiac conditions that may cause a sudden, unpredictable loss of consciousness

  1. Atrial flutter/fibrillation with bradycardia or rapid ventricular response
  2. Paroxysmal supraventricular tachycardia (PSVT), including Wolf-Parkinson-White (WPW) syndrome
  3. Prolonged, nonsustained ventricular tachycardia (VT)
  4. Sustained ventricular tachycardia (VT)
  5. Cardiac arrest
  6. High grade atrio-ventricular (AV) block
  7. Sick sinus syndrome/sinus bradycardia/sinus exit block/sinus arrest

3. Cardiac disease resulting from structural or functional abnormalities

  1. Congestive heart failure (CHF) with low output syndrome
  2. Hypertrophic obstructive cardiomyopathy
  3. Valvular disease (especially aortic stenosis)

4. Time-limited restrictions: cardiac procedures

  1. Percutaneous transluminal coronary angioplasty (PTCA)
  2. Pacemaker insertion or revision
  3. Cardiac surgery involving median sternotomy

5. Internal cardioverter defibrillator (ICD)

For the patient with known cardiac disease, the physician should strongly and repeatedly caution the patient to seek help immediately upon experiencing any symptoms—including prolonged chest discomfort, acute shortness of breath, syncope, and pre-syncope—that may indicate an unstable cardiac situation. Under no circumstances should the patient drive to seek help.

While hypertension is not included in this section, physicians should always be alert to any potential impairment in driving skills resulting from hypertensive end-organ damage or anti-hypertensive medications.


Section 2: Cardiovascular Diseases


Unstable coronary syndrome (unstable angina or myocardial infarction)

Patients should not drive if they experience symptoms at rest or at the wheel.

Patients may resume driving when they have been stable and asymptomatic for one to four weeks, as determined by the cardiologist, following treatment of the underlying coronary disease. Driving may usually resume within one week after successful revascularization by percutaneous transluminal coronary angioplasty (PTCA) and by four weeks after coronary artery bypass grafting (CABG).6 (See also recommendations for CABG.)

Cardiac conditions that may cause a sudden, unpredictable loss of consciousness

The main consideration in determining medical fitness to drive for patients with cardiac conditions is the risk of pre-syncope or syncope due to a brady- or tachyarrhythmia.7

For the patient with a known arrhythmia, the physician should identify and treat the underlying cause of arrhythmia, if possible, and recommend temporary driving cessation until control of symptoms has been achieved.

Atrial flutter/fibrillation with bradycardia or rapid ventricular response

No further restrictions once control of heart rate and symptoms has been achieved.
Paroxysmal supraventricular tachycardia (PSVT), including Wolf-Parkinson-White (WPW) syndrome

No restrictions if the patient is asymptomatic during documented episodes.

Patients with a history of symptomatic tachycardia may resume driving after they have been asymptomatic for six months on antiarrhythmic therapy.

Patients who undergo radio frequency ablation may resume driving after six months if there is no recurrence of symptoms, or sooner if no pre-excitation or arrhythmias are induced at repeat electrophysiologic testing (EP).

Prolonged, nonsustained ventricular tachycardia (VT)
No restrictions if the patient is asymptomatic during documented episodes.

Patients with symptomatic VT may resume driving after three months if they are on antiarrhythmic therapy—with or without an internal cardioverter defibrillator (ICD)— guided by invasive electrophysiologic (EP) testing, and VT is noninducible at repeat EP testing. They may resume driving after six months without arrhythmic events if they are on empiric antiarrhythmic therapy (with or without an ICD), or have an ICD alone without additional antiarrythmic therapy.8

Sustained ventricular tachycardia (VT)
Patients may resume driving after three months if they are on antiarrhythmic therapy (with or without an ICD) guided by invasive electrophysiologic (EP) testing, and VT is noninducible at repeat EP testing.

Patients may resume driving after six months without arrhythmic events if they are on empiric antiarrythmic therapy (with or without an ICD), or have an ICD alone without additional antiarrythmic therapy.8

When long-distance or sustained high-speed travel is anticipated, patients should be encouraged to have an adult companion perform the driving. Patients should avoid the use of cruise-control.8

Cardiac arrest
Please refer to the recommendations for sustained ventricular tachycardia.

If the patient experiences a seizure, please refer to the recommendations for seizure in Section 4.

If clinically significant cognitive changes persist following the patient’s physical recovery, cognitive testing is recommended before the patient is permitted to resume driving. In addition, driver evaluation (including on-road assessment) performed by a driver rehabilitation specialist may be useful in assessing the patient’s fitness to drive.

High grade atrio-ventricular (AV) block
For symptomatic block managed with pacemaker implantation, please see pacemaker recommendations.

For symptomatic block corrected without a pacemaker (eg, by withdrawal of medications that caused the block), the patient may resume driving after he/she has been asymptomatic for four weeks and EKG documentation shows resolution of the block.

Sick sinus syndrome/sinus bradycardia/sinus exit block/ sinus arrest
No restrictions if patient is asymptomatic. Regular medical follow-up is recommended to monitor progression.

For symptomatic disease managed with pacemaker implantation, please see pacemaker recommendations.

Physicians should be alert to clinically significant cognitive deficits due to chronic cerebral ischemia. Physicians may refer patients with significant cognitive changes to a driver rehabilitation specialist for a driver evaluation (including on-road assessment) to evaluate the patient’s driving safety.

Cardiac disease resulting from structural or functional abnormalities Two major considerations in determining medical fitness to drive are the risk of pre-syncope or syncope due to low cardiac output and the presence of cognitive deficits due to chronic cerebral ischemia. Patients who experience pre-syncope, syncope, extreme fatigue, or dyspnea at rest or at the wheel should cease driving.

Cognitive testing is recommended to detect cognitive deficits that may impair the patient’s driving ability. Physicians may refer patients with clinically significant cognitive changes to a driver rehabilitation specialist for an evaluation (including on-road assessment) to evaluate the patient’s driving safety.

Congestive heart failure (CHF) with low output syndrome
Patients should not drive if they experience symptoms at rest or at the wheel.

Physicians should reassess patients for driving fitness every six months to two years as needed, depending on clinical course and control of symptoms. Patients with Functional Class III CHF (marked limitation of activity but no symptoms at rest, working capacity 2 to 4 METS) should be reassessed at least every six months.

Hypertrophic obstructive cardiomyopathy
Patients who experience syncope or pre-syncope should not drive until they have been treated.

Valvular disease (especially aortic stenosis)
Patients who experience syncope or pre-syncope should not drive until the underlying disease is corrected.
Time-limited restrictions: cardiac procedures Driving restrictions for the following cardiac procedures are based on the patient’s recovery from the procedure itself and from the underlying disease for which the procedure was performed.

Percutaneous transluminal coronary angioplasty (PTCA)
The patient may resume driving 48 hours to one week after successful PTCA and/or stenting procedures, depending on the patient’s baseline condition and course of recovery from the procedure and underlying coronary artery disease.6, 9

Pacemaker insertion or revision
The patient may resume driving after one week if:
  1. The patient no longer experiences pre-syncope or syncope;
  2. EKG shows normal sensing and capture; and
  3. Pacemaker performs within manufacturer’s specifications.9

Cardiac surgery involving median sternotomy
Driving may usually resume four weeks following coronary artery bypass grafting (CABG) and/or valve replacement surgery, and within eight weeks following heart transplant, depending on resolution of cardiac symptoms and the patient’s course of recovery. In the absence of surgical and post-surgical complications, the main limitation to driving is the risk of sternal disruption following median sternotomy.

If clinically significant cognitive changes persist following the patient’s physical recovery, cognitive testing is recommended before the patient is permitted to resume driving. In addition, driver evaluation (including on-road assessment) performed by a driver rehabilitation specialist may be useful in assessing the patient’s fitness to drive.

Internal cardioverter defibrillator Please see the recommendations for nonsustained and sustained ventricular tachycardia.


6 Petch MC. European Society of Cardiology Task Force Report: Driving and heart disease. European Heart Journal. 1998;19(8):1165-1177.

7 Binns H, Camm J. Driving and arrhythmias. British Medical Journal. 2002;324:927-928.

8 Epstein AI, Miles WM, Benditt DG, et al. Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations. Circulation. 1996;94: 1147-1166.

9 Canadian Cardiovascular Society Consensus Conference. Assessment of the cardiac patient for fitness to drive. Canadian Journal of Cardiology. 1992;8:406-412.


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