Driving restrictions for patients with reflex syncope

Abstract

Reflex syncope is the most common form of syncope that occurs while driving. The 2014 revision of Japanese Road Traffic Laws placed stricter driving restrictions, along with some associated legal penalties, on individuals with recurrent syncope. “Recurrent syncope” is defined as the occurrence of more than two episodes of syncope over a period of 5 years. No restrictions are recommended for private drivers unless they experience syncope without a reliable prodrome while driving or sitting. For commercial drivers, a driving restriction is recommended unless the efficacy of treatment can be confirmed. The “risk of harm” (RH) to other road users appears to be particularly high when commercial driving is involved. The RH formula is calculated using the time of driving, the type of vehicle driven, the risk of sudden cardiac incapacitation, and the probability of a fatal or injury-producing accident. Reducing the driving time or driving a lighter vehicle can reduce the RH. Physicians should talk to their patients about driving and advise their high-risk patients to refrain from driving.

A Systematic Review of the Risk of Motor Vehicle Collision in Patients With Syncope

“…Three previous reviews were conducted on this topic, but none were systematic and each had different goals than the present work (Supplemental Discussion S1). [32][33][34] The present knowledge synthesis provides a more rigorous and extensive…”

A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk

“…Adapted from: Watanabe E et al[10]; DVLA 2018[33]; Task Force members 2009[34]; Epstein et al 1996[35]; Epstein et al 2007[36]; Klein et al[37]; EUR-Lex Directive 2006/126/EC[39]; The Expert Group on Driving and Cardiovascular Disease[40]; Lococo et al[42]; Canadian Council of Motor Transport Administration[43]; Austroads[44; Oginosawa et al[45]; Sumiyoshi. [46] AF = atrial fibrillation; ATP = antitachycardia pacing; EC = European Commission; EHRA = European Heart Rhythm Association; VT = ventricular tachycardia…”

“…[44] In Japan, regulations for drivers with cardiovascular diseases are governed by a Road Traffic Act issued by the Japanese National Police Agency. [10,45,46]…”

Driver Cardiovascular Disease Detection Using Seismocardiogram

“…The European Society of Cardiology (ESC) and the Canadian Cardiovascular Society (CCS) suggest driving restrictions in case of recurrent or unexplained syncope or substantial cardiovascular comorbidities, unless a definitive treatment can be ensured and controlled [18]. Moreover, the Japanese Circulation Society (JCS) describes driving restrictions for private and commercial patients with reflex syncope, which recommend restricting private driving until their symptoms are controlled and for commercial driving unless an effective treatment has been established [19]. The restrictions of activity unite these three risky professions and point out the importance of using a wide range of preventive actions before a sudden event happens.…”

“…As a result, many working hours are lost, and there is the threat of an accident on the road due to long working hours, weak metabolism, social isolation, low control, and work shifts [14,26]. It enforces the investigations of Canadian, German, Finnish, Swiss, Japanese [14,19], Spanish [27], and Czech Republic roads [28]. Car manufacturers have a wide range of improvements that improve drivers' working conditions and facilitate vehicle management, ergonomic solutions, and the integration of various automatic control, navigation, and alert systems [9,29,30].…”