Medical aspects of fitness to drive a guide for medical practitioners

3.3.2
Syncope and presyncope
3.3.3
Cardiac arrhythmias
Presyncope and syncope may occur secondary to arrhythmias, medications and other
factors. Driving should cease until the underlying cause(s) of presyncope and/or
syncope have been identified and effectively treated, and the individual has remained
asymptomatic for an adequate period. Where the cause of presyncope and/or syncope
is not identified, individuals should not drive for the periods outlined below.
Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or
a D, F, R, T or W endorsement (see appendix 3)
When driving should cease
An individual should not drive for a symptom‐free period of at least two months
following syncope.
When driving may resume or may occur
An individual may be fit to drive following a symptom‐free interval of at least two
months after syncope, provided there is no other condition that would render the
individual unfit to drive.
Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or
a P, V, I or O endorsement
When driving should cease
An individual is normally considered unfit to drive, unless:
• all the factors leading to presyncope or syncope have been identified and treated
effectively, and
• there is no other condition that would render the individual unfit to drive.
Fitness to drive may be assessed following a symptom‐free interval of at least three
months after syncope. The Agency may impose licence conditions for regular medical
assessment, eg annual reviews.
Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or
a D, F, R, T or W endorsement (see appendix 3)
See section 3.3.4 for individuals who have a pacemaker implanted.
Atrial fibrillation does not normally require driving restrictions unless complicated by
episodes of syncope or dizziness. In these circumstances, individuals should not drive
until the condition has stabilised under satisfactory treatment.
The situation with regard to other forms of arrhythmias, such as supraventricular
tachycardias, Wolff‐Parkinson‐White syndrome and other conduction disorders, will
depend on any history of collapse, dizziness or syncope. A symptom‐free period of
at least three months on treatment or following corrective surgery will normally be
required before allowing individuals to resume driving.
Individuals not treated by curative surgery may be required to have an annual
cardiologist assessment as a condition for holding a licence to drive.
An individual who has undergone radiofrequency ablation may be fit to drive six weeks
after it if:
• assessed by a specialist
• there is an absence of symptoms
• an ECG is normal, where relevant
• there is no other condition that would render the individual unfit to drive.
Individuals with untreated ventricular tachycardia should not drive. Individuals with
ventricular tachycardia or any arrhythmia likely to cause syncope or predispose to
sudden death are generally considered unfit to drive.
Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or
a P, V, I or O endorsement
Individuals with a history of recurrent or persistent arrhythmia should be considered
unfit to apply for and hold a licence. Individuals with uncomplicated atrial fibrillation
do not generally have driving restrictions unless complicated by episodes of syncope
or dizziness or other symptoms. A period of at least six months free of symptoms is
generally required and licences may be subject to the condition of an annual cardiac
assessment. Individuals with ventricular tachycardia or any arrhythmia likely to
cause syncope or predispose to sudden death are generally considered unfit to drive.
The Agency may consider granting individuals with a licence or endorsement based on
a supporting specialist report where sound reasons exist.
50 3. Cardiovascular conditions | Medical aspects of fitness to drive | NZTA July 2009
July 2009 NZTA | Medical aspects of fitness to drive | 3. Cardiovascular conditions 51