Ordinary motorcycles, cars, small vehicles with or without a trailer (categories A, B) The following discussion will focus on the driving restrictions in patients at risk of syncope and cardiac arrhythmias associated with sudden incapacity. Syncope may still occur in patients who develop VT/VF despite having an ICD because of the time delay between arrhythmia occurrence, effective treatment and restoration of normal brain perfusion. While pacemakers can effectively prevent the occurrence of bradyarrhythmias, ICDs do not prevent VT/VF but treat those rhythms once they happen by either overdrive antitachycardia pacing (ATP) or internal cardioversion. SCD is mostly arrhythmic in nature, with ventricular tachycardia (VT) and VF responsible for >75% of cases.Ĭardiac pacemakers are used to treat patients with – or those at risk of developing – significant bradyarrhythmias, while ICDs are used to treat patients who are at high risk of SCD as a result of VT/VF. It is irreversible if prompt resuscitation is not applied. SCD is an unexpected death from a cardiac cause, which occurs within one hour from the start of any cardiac-related symptoms. Syncope can be neurally mediated, caused by orthostatic hypotension or by cardiac conditions – mostly arrhythmic events (either brady- or tachyarrhythmias). Syncope is defined as a transient loss of consciousness event that results from general brain hypoperfusion. Sudden incapacity can result from a syncopal event, a sudden cardiac death (SCD), or a neurological event such as seizure or stroke. Syncope and Incapacitation as a Result of Arrhythmia The development of driverless technologies may also have an impact on decision making in this field. Ultimately, a more individual assessment of risk with a combined assessment of the medical condition and the patient's driving behaviour may be appropriate. The assumptions on which these calculations are based are now old and less likely to reflect the reality of modern driving. Quantification of the potential risk of harm associated with various categories of drivers has attempted to make these regulations more objective. Significant variation occurs between these rules in different countries and legislatures. Cardiovascular conditions are a primary cause for sudden incapacitation and regulations have long existed to restrict driving for patients with cardiac conditions at high risk of sudden incapacitation. Sudden incapacitation while driving can result in injury or death for the driver and passengers or bystanders. The ability to drive is a highly valued freedom in the developed world.
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