Driving safety among patients with neurocardiogenic (Vasovagal) syncope

The purpose of this study was 50 evaluate the risk of injury due to syncope while driving and the driving habits of patients with neurocardiogenic (va sovagal) syncope. Neurocardiogenic syncope is one of the most common causes of syncope. However, the important issue of driving related injury due to syncope in this population is not well defined. Risk of injury due to synco pe while driving and driving behavior was evaluated in 155 consecutive pati ents (92 women and 63 men; mean age 49 +/- 19 years) with history of syncop e in whom hypotension and syncope or presyncope could be provoked during he ad-up tilt testing. Patients with syncope and positive head-up tilt table t est were treated with pharmacological therapy. All participants were asked to fill out a detailed questionnaire regarding any driving related injuries and their driving behavior before tilt table testing and during follow-up. Prior to head-up tilt testing two patients had syncope while driving, and one of these patients had syncope related injury during driving. The mean d uration of syncopal episodes was 50 +/- 14 months (range 22-72 months). Of the 155 patients, 52 (34 %) had no warning prior to syncope, while 103 (6%) had warning symptoms such as dizziness prior to their clinical syncope. Fo llowing a diagnosis of neurocardiogenic syncope established by head-up tilt testing, six patients stopped driving on their own. During a median follow -up of 22 months recurrent syncope occurred in five (3.2%) patients. No pat ient had syncope or injury during driving. In conclusion, syncope and injur y while driving in patients with neurocardiogenic syncope is rare. The prec ise mechanism of this is unclear but may be related to posture during drivi ng. Consensus among the medical community will be needed to provide specifi c guidelines in these patients.