Potential risk of vasovagal syncope for motor vehicle driving

Vasovagal syncope is the most common cause of syncope, but its risk for dri ving remains uncertain. We analyzed the clinical characteristics of patient s who had syncope during driving and subsequently underwent the head-up til t test (HUTT). Of the 245 consecutive patients undergoing HUTT, 23 (9%) had greater than or equal to 1 episode of syncope during driving. HUTT was pos itive in 19 (group A) and negative in 4 (group B) patients. No patient had structural heart disease. In group A, the driving incident occurred on the first syncope in 3 patients, and the other 16 patients had 1 to 4 episodes of prior syncope not associated with driving. In group B, the driving incid ent occurred on the first syncope in 1 patient, and the other 3 patients he rd prior syncope (3 episodes in each) not associated with driving. Seven gr oup A and 1 group B patients had 2 syncope-related driving incidents, and t he remaining patients had only 1 syncope-related driving incident. The sync ope-related driving incidents caused personal injury in 7 group A and 2 gro up B patients. One incident in 1 group A patient caused the death of anothe r driver. After HUTT, all but 1 patient in group A received medical treatme nt and only 1 patient in group B received empirical beta-blacker therapy. D uring the follow-vp of 51 +/- 26 months, 1 patient died and another was los t to follow-up. Of the remaining patients, 4 patients had recurrence of syn cope and 2 patients had presyncope in group A. One of these patients had an other syncope-related driving incident. No group B patient had syncope recu rrence. A second etiology of syncope was never found in any patient, We con clude that vasovagal syncope during driving is not uncommon in patients ref erred for syncope evaluation. Early medical attention to patients with vaso vagal syncope may help reduce syncope-related driving incidents. (C) 2000 b y Excerpt-a Medico, Inc.