Isolated arrhythmia, bradyrrhythmia, syncope, medications, and their effects on driving

Isolated extrasystoles

Isolated abnormality in heart rhythm constitutes benign arrhythmia that does not require treatment, except when it causes a lot of symptoms or triggers more serious arrhythmia.

That is why the situation should be studied to rule out possible triggers or cardiopathy.These include auricular and ventricular extrasystoles, and errant auricular pacemakers.

Advice on Isolated abnormality in heart rhythm

• In the absence of cardiopathy, toxic habits such as coffee, alcohol and smoking should be avoided, especially as the latter two of these also affect driving.
• Mild sedatives may be required in some cases. Patients should not drive if they have symptoms or if the sedative treatment is inducing sleepiness or affecting the reflexes.
• Ventricular extrasystoles associated with cardiopathy, especially with ischemia, when repeated in pairs or trios or which are more frequent than ten per hour using Holter 24-hour monitoring, are associated with an increased risk of sudden death, meaning driving is contraindicated.

Bradyarrhythmias

Bradyarrhythmias are slow rhythms of heart rate < 60 beats/ minute, which may or may not cause symptoms.Its variations are sinusal bradycardia, sinusal pause, sinoauricular blockages and auricular-ventricular blockages, each with three degreesThey can manifest as syncope, stress dyspnoea, tiredness and heart failure.

Symptomatic bradycardia such as the 2nd degree AV block Mobitz II and third degree cases require a pacemaker to be fitted.

Advice on Bradyarrhythmias

• Patients suffering from symptomatic bradyarrhythmia may not drive until the cause is diagnosed, and the treatment proposed must be effective without causing risks of syncope.
• A well-adapted pacemaker may permit driving after a sufficient time has been allowed to confirm its efficacy, and a report has been issued by a doctor.

Vasovagal syncope

Vasovagal syncope causes of loss consciousness related to hypotension due to vasodilatation and brachycardia, and is more common in the young.

It is preceded by vegetative symptoms such as nausea, vomiting, yawning, a feeling of heat, abdominal discomfort, paleness, sweating, etc.It can be an isolated episode, or it can reoccur over a period of weeks, months or even throughout the patient’s life. Triggering factors should be dealt with, such as a hot environment, dehydration, emotional stress and pain.If this is not sufficient, medication such as beta blockers, corticoids, theophylline and anticholergenics can be used. A salt-rich diet is recommended.

Advice on Vasovagal syncope

• Keep the atmosphere inside the car cool.
• During long journeys drink lots of water when you stop, and don’t hold in urine.
• Advise the patient that if he notices premonitory symptoms while driving he should park up as soon as possible without risking an accident, relax, rest for a sufficient period, drink water, and if he does not feel well he should seek assistance and refrain from driving.
• In the case repeated vasovagal syncope, the driver should drive with a companion or refrain from driving.
• Feeling insecure can lead the driver to feel afraid he is going to have a fainting spell and this will mean he can’t drive, and can even cause syncope.
• There is usually an underlying problem with anxiety that requires treatment, and the patient should be warned that any anti-anxiety medication prescribed can produce sleepiness, which makes driving difficult.

Antiarrhythmic agents and their effects on driving

Antiarrhythmic agents play a vital role in the management of the majority of serious cases of arrhythmia.

All the medications have their limitations, which can even worsen or improve the appearance of other arrhythmias.

Drug treatments and doses often need to be changed until the most suitable agent is found.

Advice on Antiarrhythmic

• Therefore, the management of arrhythmia is not simple, and until control is achieved there is a risk of adverse reactions and driving should not be allowed.
• The doctor should explain to his patient that although he might apparently feel well, he should refrain from driving for his own safety and the safety of others.

Advice on Non-pharmacological treatment of arrhythmia

The invasive treatment of arrhythmia allows driving, after a safe, arrhythmia-free period has passed, and when the specialist has given permission after several evaluations by means of a report stating driving can be allowed.

When the arrhythmia threatens to produce syncope or sudden death, or is associated with symptomatic cardiac disease, driving should not be allowed.

Arrhythmia controlled by medication allows the patient to drive, if the associated disease is also under control, and if the patient is warned of the possible side effects of the medication.

Side effects of the medications

• Can cause nausea, trembling and mental confusion.
• Possible side effects include somnolence, nausea, vomiting, dysarthria, diplopia, nystagmus, ataxia, trembling, paresthesia, hypotension, etc.
• Can cause dizziness and blurred vision.
• This sometimes causes hypotension, bronchospasm, sleepiness, vertigo, motor dysfunction and paresthesia.
• This occassionally causes corneal deposits, paresthesia, trembling, atxia, serious intersticial neumonitis and thyroid dysfunction.
• Can cause hypotension, headaches, dizziness, nistagmus, nausea, abdominal discomfort and urinary spasm.
• Nausea, vomiting, diarrhoea, anorexia, blurred vision, diplopia, headache, mental disorders, etc. Because of its narrow therapeutic range, digitalis intoxication is frequent.
• Non-pharmacological treatment of arrhythmia

This is aimed at cases of arrhythmia where the patient’s life is in danger, young people where it is preferable to avoid initiating life-long medication, and those patients who, although they are well controlled, have developed serious side effects.

There are a variety of methods, ranging from the ablation of the anatomical substratum of the arrhythmia, the pacemaker, the implantable defibrillator, surgery and emergency electrical cardiovesion.