Vasovagal Syncope and Driving

Study Questions:

What is the likelihood of a motor vehicle accident causing serious risk or harm in patients with frequent vasovagal syncope?

Methods:

Data were from the POST (Prevention of Syncope Trial) -1 and -2, which were multicenter randomized studies of patients with ≥3 lifetime vasovagal syncope spells. POST-1 patients received metoprolol or placebo for ≤1 year; POST-2 patients received fludrocortisone or placebo for ≤1 year. The POST patient accident data were compared with that of the general population of drivers in the United States, United Kingdom, and Canada.

Results:

A total of 418 patients (mean age 38 years) had a median of 10 lifetime faints and a median of three faints in the previous year. Total follow-up time was 0.77 years per person. A total of 174 subjects fainted, having a total of 615 faints. Two patients fainted while driving, without fatality or injury, with a likelihood of 0.62% per person-year. The risk of serious harm or death was <0.0035% per person-year, and 0.0018% per faint. In the general United States, United Kingdom, and Canadian driving populations, the risk of serious harm or death was 0.067% per driver-year, and the risk of death was 0.009%.

Conclusions:

The estimated risk of serious harm or death was <0.0035% per person-year in highly symptomatic syncope patients, less than the risk of serious harm or death in the general population.

Perspective:

A sudden loss of consciousness while driving may cause a motor vehicle accident, serious injury, or death of the vehicle occupants or other motorists and pedestrians. Legal restrictions on the ability to drive for patients with a predilection to syncope vary significantly among jurisdictions, but most prohibit driving for 3-12 months. The risk of syncope while driving among patients with frequent episodes of vasovagal syncope appears to be very low in this study. While most patients in the study were from Alberta and were most likely told to abstain from driving for only a week, and the follow-up was <1 year, the prospective design for a study on this topic is novel and certainly a plus. Alas, we do not know whether patients in this study restricted their driving and how much.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Accidents, Traffic, Arrhythmias, Cardiac, Automobile Driving, Fludrocortisone, Metoprolol, Primary Prevention, Risk, Syncope, Syncope, Vasovagal


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