Guidance

Cardiovascular disorders: assessing fitness to drive

Advice for medical professionals to use when assessing drivers with cardiovascular disorders.

✘- Must not drive ! - May continue to drive subject to medical advice and/or notifying the DVLA ✓- May continue to drive and need not notify the DVLA

Angina

  Group 1
car and motorcycle
Group 2
bus and lorry
Angina ✘- Must not drive when symptoms occur:

■ at rest
■ with emotion
■ at the wheel.

Driving may resume after satisfactory symptom control.

Need not notify the DVLA.

✘- Must notify the DVLA.

Must not drive when symptoms occur.

A licence will be refused or revoked if symptoms continue (treated or untreated).

May be relicensed/licensed (provided there is no other disqualifying condition) if:

■ no angina for at least 6 weeks
■ the requirements for exercise or other functional tests can be met (see Appendix C).

Acute coronary syndromes (ACS)

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - Must not drive but need not notify the DVLA.

Driving may resume 1 week after ACS if successful coronary intervention (PCI) and if all of the following are met:

■ no other urgent revascularisation planned (urgent means within 4 weeks of acute event)
■ LV ejection fraction is at least 40% before hospital discharge
■ there is no other disqualifying condition.

If not treated by successful coronary intervention or any of the above are not met, driving may resume only after 4 weeks from the acute event, provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA – for all ACS.

Licence will be refused or revoked.

May be relicensed/licensed after at least 6 weeks if:

■ LV ejection fraction is at least 40%
■ the requirements for exercise or other functional tests can be met (see Appendix C)
■ there is no other disqualifying condition.

Elective percutaneous coronary intervention (PCI)

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive for at least 1 week but need not notify the DVLA.

Driving may resume after 1 week provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

May be relicensed/licensed after at least 6 weeks if:

■ LV ejection fraction is at least 40%
■ the requirements for exercise or other functional tests can be met (see Appendix C)
■ there is no other disqualifying condition.

Coronary artery bypass graft (CABG)

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive for at least 4 weeks but need not notify the DVLA.

Driving may resume after 4 weeks provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

May be relicensed/licensed after 3 months if:

■ LV ejection fraction is at least 40%
■ the requirements for exercise or other functional tests can be met (see Appendix C), at least 3 months postoperatively
■ there is no other disqualifying condition.

Arrhythmias

Arrhythmias include:

  • sinoatrial disease
  • significant atrioventricular conduction defect
  • atrial flutter/fibrillation
  • narrow or broad complex tachycardia.

Note:

  • if a transient arrhythmia occurs during an acute coronary syndrome, the guidance relating to ACS takes precedence
  • pacemakers are considered separately.
  Group 1
car and motorcycle
Group 2
bus and lorry
Arrhythmia ✘- Must not drive if arrhythmia has caused or is likely to cause incapacity.

Driving may resume without DVLA notification only after:

■ underlying cause has been identified
■ arrhythmia is controlled for at least 4 weeks.

Must notify the DVLA if there are distracting or disabling symptoms and/or arrhythmia is not controlled for at least 4 weeks, and an underlying cause has not been identified.
✘- Must notify the DVLA.

Must not drive if arrhythmia has caused or is likely to cause incapacity.

Licence will be refused or revoked.

May be relicensed/licensed (provided there is no other disqualifying condition) only after:

■ underlying cause has been identified
■ arrhythmia has been controlled for at least 3 months
■ LV ejection fraction is at least 40%.

Successful catheter ablation

  Group 1
car and motorcycle
Group 2
bus and lorry
For arrhythmia causing or likely to cause incapacity ✘- Must not drive for at least 2 days but need not notify the DVLA.

Driving may resume after 2 days provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Driving may resume after 6 weeks provided there is no other disqualifying condition.
For arrhythmia not causing or likely to cause incapacity ✘- Must not drive for at least 2 days but need not notify the DVLA.

Driving may resume after 2 days provided there is no other disqualifying condition.
✘- Must not drive for at least 2 weeks but need not notify the DVLA.

Driving may resume after 2 weeks provided there is no other disqualifying condition.

Pacemaker implant – including box change

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive for at least 1 week and must notify the DVLA.

Driving may resume after 1 week provided there is no other disqualifying condition.
✘- Must not drive for at least 6 weeks and must notify the DVLA.

Driving may resume after 6 weeks provided there is no other disqualifying condition.

Congenital complete heart block

  Group 1
car and motorcycle
Group 2
bus and lorry
Asymptomatic ✓- May drive and need not notify the DVLA. ✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently until pacemaker implanted.
Symptomatic ✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked until pacemaker implanted.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently until pacemaker implanted.

Implantable cardioverter defibrillator (ICD)

Group 1 car and lorry drivers

In all cases of ICD implanted for sustained ventricular arrhythmia associated with incapacity, driving must stop for 6 months from the date of ICD implantation and any resumption requires:

  • the device being under regular review with interrogation
  • no other disqualifying condition
  • all the requirements as below must be met.

Group 2 bus and lorry drivers

ICD implantation is a permanent bar to Group 2 licensing. In all cases of ICD implantation (including prophylactic ICD implantation) driving must stop permanently and:

  • the DVLA must be notified
  • the licence will be refused or revoked permanently.
</tbody>
Group 1
Car and motorcycle
Group 2
Bus and lorry
ICD implanted for sustained ventricular arrhythmia associated with incapacity
Without further sequelae ✘- Must not drive and must notify the DVLA.

Driving may resume after 6 months following implantation – except that any of the sequelae 1-4 below require further specific restrictions and may require notification to the DVLA.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
1. With any shock therapy and/or symptomatic anti-tachycardia pacing (see below for therapy with incapacity) ✘- Must not drive for 6 months from the time of any shock therapy and/or symptomatic anti-tachycardia pacing.

Must notify the DVLA.

Driving may resume after 6 months provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
2. With any therapy associated with incapacity (whether incapacity caused by device or arrhythmia) ✘- Must not drive for 2 years after symptoms of incapacity and must notify the DVLA.

Exceptions to this 2 year requirement apply as follows.

a. If therapy delivery was due to an inappropriate cause such as atrial fibrillation or programming issues:
■ driving may resume 1 month after complete control of any cause to the satisfaction of the cardiologist. The DVLA need not be notified.

b. If therapy delivery was appropriate due to sustained ventricular tachycardia or ventricular fibrillation, driving may resume 6 months after event:

■ provided preventive steps against recurrence have been taken with anti-arrhythmic drugs or ablation procedure, for example
■ and there is an absence of further symptomatic therapy.

Must notify the DVLA.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
3. With any revision of electrodes or anti-arrhythmic drug treatment ✘- Must not drive for 1 month but need not notify the DVLA.

Driving may resume 1 month after electrode revision or drug alteration provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
4. With defibrillator box change ✘- Must not drive for 1 week but need not notify the DVLA.

Driving may resume 1 week after box change provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
ICD implanted for sustained ventricular arrhythmia not associated with incapacity
! - Must not drive for 1 month following implantation and must notify the DVLA.

Driving may resume 1 month after implantation provided all of the following are met:

■ presentation was a ‘non-disqualifying’ cardiac event – i.e. haemodynamically stable sustained ventricular tachycardia without incapacity
■ LV ejection fraction is greater than 35%
■ any VT induced on electrophysiological study has RR interval greater than 250 milliseconds
■ during the post-implantation electrophysiological study, any induced VT could be pace-terminated by the ICD twice, without acceleration.
If any of the above not met, must not drive for 6 months following implantation.

Note: should ICD subsequently deliver symptomatic anti-tachycardia pacing and/or shock therapy (except during normal clinical testing), the DVLA must be notified and the relevant restrictions must be applied as detailed under the heading ICD implanted for sustained ventricular arrhythmia associated with incapacity).
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.
Prophylactic ICD
In asymptomatic individuals with a high risk of significant arrhythmia ✘- Must not drive for 1 month following implantation and must notify the DVLA:

■ driving may resume 1 month after implantation if remains asymptomatic and no ICD therapy needed
■ should the ICD subsequently deliver symptomatic anti-tachycardia pacing and/ or shock therapy (except during normal clinical testing), the DVLA must be notified and relevant restrictions must be applied as detailed under the heading 'ICD implanted for sustained ventricular arrhythmia associated with incapacity).
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Aortic aneurysm – ascending or descending thoracic and/or abdominal

All patients must have regular medical review. Note: for Group 2 cases, the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm irrespective of the diameter.

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - May drive and need not notify the DVLA if aneurysm diameter is less than 6 cm. ! - May drive if the aneurysm diameter is less than 5.5 cm. Must notify the DVLA.

Note: the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm irrespective of the diameter.
  ! - May drive but must notify the DVLA if aneurysm diameter is between 6 cm and 6.4 cm.

May be relicensed/licensed subject to annual review.
✘- Must not drive and must notify the DVLA if the aneurysm diameter is greater than 5.5 cm.

Licence will be refused or revoked.

May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and no other disqualifying condition.

Note: the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm irrespective of the diameter.
  ✘- Must not drive and must notify the DVLA if aneurysm diameter is 6.5 cm or greater.

Licence will be refused or revoked.

May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and no other disqualifying condition.

In cases of bicuspid aortopathy, maximum aortic diameter should be less than 6.5 cm.
! - May drive and may need to notify the DVLA - see following.














In cases of bicuspid aortopathy, maximum aortic diameter should be less than 5.5cm provided there is no associated coarctation of aorta, systemic hypertension, family history of aortic dissection and aneurysmal growth is no greater than 3mm per annum. If any of the above apply, the maximum aortic diameter allowed would be less than 5cm.

Note: the exercise or other functional test requirements will need to be met in all cases of abdominal aortic aneurysm irrespective of the diameter.

Chronic aortic dissection

Note: ‘well controlled’ blood pressure means clinically relevant to aortic dissection, not the DVLA standard for hypertension.

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘ - Must not drive. Must notify the DVLA if aortic diameter greater than 6 cm.

Driving may resume only after satisfactory surgical intervention and/or:
■ satisfactory medical therapy (blood pressure well controlled)
■ medical follow-up
■ no other disqualifying condition.

If aortic diameter is 6 cm or greater, the driving restrictions given under aortic aneurysm (see above) must take effect, with the DVLA notified.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

May be relicensed/licensed only after satisfactory surgical intervention and/or all the following are met:

■ satisfactory medical therapy (blood pressure well controlled)
■ maximum transverse diameter of the aorta is less than 5.5 cm (including the false lumen/thrombosed segment)
■ complete thrombosis of the false lumen
■ medical follow up in place.

Marfan syndrome and other inherited aortopathies

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - May drive and need not notify the DVLA if no aneurysm.

If there is an aortic aneurysm, must notify the DVLA and must not drive if aortic diameter greater than 5 cm or any other disqualifying condition.
✘- Must notify the DVLA.

Must not drive if maximum aortic diameter greater than 5 cm or associated with severe aortic regurgitation or any other disqualifying condition.

Licence will be revoked/refused.

Relicensing will be considered only if:

■ maximum aortic diameter is less than 5 cm
■ there is no family history of aortic dissection
■ there is no severe aortic regurgitation
■ is under annual cardiac review to include aortic root measurement.

If there is a family history of dissection, relicensing will only be allowed if aortic diameter is less than 4.5 cm.

Aortic root replacement - debarred if emergency aortic root surgery.

Elective aortic root surgery - individual assessment (see Appendix C for full details).

For aortic root replacement, driving may be relicensed after an individual assessment (see Appendix C).

Peripheral arterial disease

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✓ - May drive and need not notify the DVLA.

There must be no other disqualifying condition.
! - May drive but must notify the DVLA.

May be relicensed/licensed only if:

■ there is no symptomatic myocardial ischemia, and
■ the exercise or other functional test requirements can be met (see Appendix C).

Hypertension

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - May drive and need not notify the DVLA, except:

✘- Must not drive if diagnosed with malignant hypertension until condition has been effectively treated or controlled but need not notify DVLA. (Malignant hypertension: elevation in systolic blood pressure greater than or equal to 180 mmHg or diastolic blood pressure greater than or equal to 110 mmHg associated with evidence of progressive organ damage.)
! - May drive and need not notify the DVLA, except:

✘- Must not drive and must notify the DVLA if resting BP is consistently:

■ 180 mm Hg or higher systolic and/or
■ 100 mm Hg or more diastolic
■ or if diagnosed with malignant hypertension.

May be relicensed/licensed after BP is controlled, provided there are no side-effects from treatment that affect or are likely to affect safe driving.

Cardiomyopathies

Note: the DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction is less than 40%.

Also refer to the following sections in this document:

</tr>
Group 1
Car and motorcycle
Group 2
Bus and lorry
Hypertrophic cardiomyopathy (HCM)
Asymptomatic ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Must not drive if in the High Risk group (as per ESC HCM Risk-SCD calculator - see Appendix C for details) and/or if ICD is indicated/implanted. Licence will be refused/revoked. If in the Low Risk or Intermediate Risk group licensing will be permitted if the exercise tolerance test requirements are met with at least a 25mm Hg increase in systolic blood pressure during exercise testing (testing to be repeated every 3 years) (see Appendix C for details).
Symptomatic ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition (must meet all other relevant standards, eg angina, arrhythmia).
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing will be considered once symptoms are satisfactorily controlled and the criteria for asymptomatic HCM met as detailed above. If there is a history of associated syncope the standards for syncope need to be met in addition.
Dilated cardiomyopathy
Asymptomatic ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
! - May drive but must notify the DVLA.

LV ejection fraction must be at least 40% and there must be no other disqualifying condition.
Symptomatic ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence may be issued/renewed once asymptomatic, if LV ejection fraction is at least 40% and there is no other disqualifying condition.
Arrhythmogenic right ventricular cardiomyopathy and allied disorders
Asymptomatic ✓- May drive and need not notify the DVLA. ✘- Must not drive and must notify the DVLA.

May be relicensed/licensed following specialist electrophysiological assessment, provided there is no other disqualifying condition.
Symptomatic ✘- Must not drive and must notify the DVLA if arrhythmia has caused or is likely to cause incapacity.

May be relicensed/licensed once arrhythmia is controlled, provided there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing may be permitted if:

■ the applicant is on treatment
■ the applicant has remained asymptomatic for a period of 1 year and
■ the applicant remains under regular specialist electrophysiological review.

A 1-3 year licence may be considered if the specialist electrophysiological review is satisfactory.

Heart failure

Refer to NYHA classification detailed below.

  Group 1
car and motorcycle
Group 2
bus and lorry
Asymptomatic NYHA Class 1 ✓- May drive and need not notify the DVLA. ! - May drive if LV ejection fraction is at least 40% but must notify the DVLA.
Symptomatic    
NYHA class II ! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify the DVLA. ! - May drive if left ventricular ejection fraction is at least 40%, symptoms are stable and not likely to distract the driver or otherwise affect safe driving but must notify the DVLA.
NYHA class III ! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify the DVLA. ✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%.
NYHA class IV ✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing can only be considered if symptoms controlled and in NYHA 1, II or III.
✘ - Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%.

Depending on the likely cause for heart failure, exercise or other functional testing may be required irrespective of the NYHA class (see Appendix C).
Left ventricular assist device implanted ✘- Must not drive but need not notify the DVLA.

Driving may be relicensed under individual assessment only after 3 months from implantation.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

New York Heart Association (NYHA) classification of heart failure

The New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):

  • class I no limitation of physical activity – ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)

  • class II slight limitation of physical activity – patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)

  • class III marked limitation of physical activity – although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically ‘moderate’ heart failure)

  • class IV inability to carry out any physical activity without discomfort – symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically ‘severe’ heart failure)

Cardiac resynchronisation therapy (CRT)

  Group 1
car and motorcycle
Group 2
bus and lorry
CRT pacemaker ✘- Must not drive for 1 week and must notify the DVLA.

Driving may resume after at least 1 week following implantation if:

■ there are no symptoms likely to affect safe driving
■ there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Driving may resume after at least 6 weeks following implantation if:

■ LV ejection fraction is at least 40%
■ the requirements under heart failure section (see above) are met
■ there is no other disqualifying condition.
CRT defibrillator ! - May drive subject to following provisions being met but must notify the DVLA.

Provisions:

■ the requirements under implantable cardioverter defibrillator (ICD) are met
■ there is no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Heart transplant – including heart and lung transplant

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive for at least 6 weeks after surgery.

Need not notify the DVLA.

There must be no other disqualifying condition.
✘- Must not drive for at least 3 months following surgery and must notify the DVLA.

May be relicensed after 3 months provided:

■ remains asymptomatic
■ any exercise or other functional testing requirements from the DVLA are met
■ LV ejection fraction at least 40%
■ there is no other disqualifying condition.

Established diagnosis of pulmonary hypertension (under the care of a specialist centre)

  Group 1
car and motorcycle
Group 2
bus and lorry
  ! - Must notify the DVLA.

May drive provided satisfactory specialist assessment and deemed to be at less than 20% per annum risk of a sudden disabling event.

Individual assessment required.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked if in the intermediate or high risk group.

If in the low group, driving may be allowed provided satisfactory specialist assessment and risk of a sudden and disabling event deemed to be less than 2% per annum.

Classification of low, intermediate or high risk as per 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

Heart valve disease

Note:

</tbody>
Group 1
Car and motorcycle
Group 2
Bus and lorry
Heart valve disease
Asymptomatic ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
Symptomatic (please refer to heart failure standards if relevant) ✓- May drive and need not notify the DVLA.

May be licensed/relicensed if there are no other disqualifying conditions and free of symptoms.
✘- Must not drive and must notify the DVLA.

Relicensing considered following cardiological assessment.

Aortic stenosis (to include sub-aortic and supra-aortic stenosis, RVOT obstruction)

See Appendix C for the definition of ‘severe’ asymptomatic aortic stenosis.

  Group 1
car and motorcycle
Group 2
bus and lorry
Asymptomatic ✓- May drive and need not notify the DVLA. ✘- Must not drive and must notify the DVLA.

If mild to moderate aortic stenosis, may drive and need not notify DVLA. Moderate aortic stenosis must be under regular medical review and DVLA must be notified if this progresses to severe aortic stenosis.

If severe aortic stenosis, an annual review licence may be issued, provided:

■ the DVLA exercise tolerance test requirements are met (see Appendix C)
■ there is satisfactory medical follow-up.

Licensing will be refused if:

■ during an exercise test symptoms develop, blood pressure falls or there is sustained arrhythmia
■ a cardiologist considers that exercise testing would be unsafe for the individual
■ a test is not possible for any other reason.
Symptomatic ✘- Must not drive and must notify the DVLA if severe aortic stenosis and symptoms that may impact safe driving.

Licence will be refused or revoked pending assessment and treatment.
✘- Must not drive and must notify the DVLA.

Licence will be refused or revoked pending assessment and treatment.

Heart valve surgery – including transcatheter aortic valve implantation and other cardiac or pulmonary percutaneous devices

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive for 4 weeks but need not notify the DVLA.

Driving may resume only after 4 weeks, provided there is no other disqualifying condition.
✘- Must not drive for 3 months and must notify the DVLA.

May be relicensed/licensed only after 3 months, provided:

■ no evidence of significant left ventricular impairment – that is, LV ejection fraction at least 40%
■ no ongoing symptoms
■ no other disqualifying condition.

Congenital heart disease (CHD)

  Group 1
car and motorcycle
Group 2
bus and lorry
Asymptomatic ! - May drive and need not notify the DVLA if asymptomatic and does not fall under any other category which requires notification to the DVLA. ! - May drive, but must notify the DVLA. Licence will be refused or revoked if CHD is complex or severe.

Otherwise, the DVLA may issue a licence for medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is:

■ minor disease
■ successful cardiac or pulmonary intervention (percutaneous device or surgery)
■ no other disqualifying condition.
Symptomatic ✘- Must not drive and must notify the DVLA.

Symptoms include angina, palpitations, dyspnoea, symptoms related to uncontrolled hypertension, heart failure, heart valve disease.

For patients with congenital heart disease who have had ablation, pacemaker including CRT, ICD, heart valve intervention (surgical or percutaneous) or percutaneous cardiac/pulmonary devices (ASD/VSD/coarctation/MAPCAs/pulmonary-systemic shunts etc) - if symptoms develop after being asymptomatic or if they fall under any other category which requires notification to the DVLA, must notify the DVLA.

Individual assessment of symptomatic cases.

The DVLA may require specialist assessment to issue a licence, which may be subject to medical review at 1, 2 or 3 years.

There must be no other disqualifying condition.
✘- Must not drive and must notify the DVLA. Licence will be refused or revoked if CHD is complex or severe.

Otherwise, following individual assessment of cases, the DVLA may issue a licence subject to medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is:

■ minor disease
■ successful cardiac or pulmonary intervention (percutaneous device or surgery)
■ no other disqualifying condition.

For syncope, refer to Chapter 1.

ECG abnormality – suspected myocardial infarction

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
✘- Must not drive and must notify the DVLA.

May be relicensed/licensed, provided:

■ exercise or other functional test requirements from the DVLA are met (see Appendix C)
■ there is no other disqualifying condition.

Left bundle branch block

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
! - May drive but must notify the DVLA.

May be relicensed/licensed if:

■ myocardial perfusion scan or stress echocardiography requirements from the DVLA are met (see Appendix C)
■ there is no other disqualifying condition.

Pre-excitation

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✓- May drive and need not notify the DVLA.

There must be no other disqualifying condition.
! - May drive and need not notify the DVLA, except:

If associated with arrhythmia must meet the relevant requirements (see arrhythmias)

There must be no other disqualifying condition.

Long QT syndrome - all cases of Long QT syndrome must notify the DVLA

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘ - Must not drive if history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA.

Licence will be refused/revoked.

Relicensing will be considered upon appropriate specialist cardiologist assessment and standards of syncope met.
✘ - Must not drive if symptomatic or history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA.

Licence will be refused/revoked.

Relicensing may be considered once asymptomatic and upon appropriate specialist cardiologist assessment and standards of syncope met.

* corrected QTc interval

Brugada syndrome - all cases of Brugada syndrome must notify the DVLA

  Group 1
car and motorcycle
Group 2
bus and lorry
  ✘- Must not drive if history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death and must notify DVLA.

Licence will be refused/revoked.

Relicensing will be considered upon appropriate specialist cardiologist assessment.
✘ - Must not drive if symptomatic or history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death and must notify DVLA.

Licence will be refused/revoked permanently if history of syncope possibly associated to Brugada syndrome or history of sudden aborted cardiac death.

Otherwise, relicensing may be considered once asymptomatic and upon appropriate specialist cardiologist assessment and standards of syncope met.
Published 11 March 2016
Last updated 31 August 2018 + show all updates
  1. Changes to 'Arrhythmia' and 'Implantable cardioverter defibrillator' sections. Inclusion of standards for pulmonary hypertension.
  2. As a consequence of both panel review and upcoming changes to European legislation, several changes have been made to this chapter. There are entirely new sections on: Long QT syndrome; Brugada syndrome; and a completely rewritten section on cardiac failure. Several standards relating to a range of cardiac and related conditions have been clarified and/or supplemented to take account of changes in medical and related therapies. These include: implantable cardioverter defibrillators; aortic aneurysm and aortic dissection; high blood pressure (hypertension); cardiomyopathies; aortic stenosis; and congenital heart disease.
  3. Clarification of standards for implantable cardioverter defibrillator. Clarification of standards for aortic aneurysm. Clarification of standards for hypertrophic cardiomyopathy with inclusion of the European Society of Cardiology Risk of Sudden Cardiac Death calculator (Appendix C).
  4. ‘Aortic aneurysm’ – layout changed to aid clarity. New section added called ‘Thoracic aortic aneurysm with bicuspid aortopathy’. ‘Congenital heart disease’ – revised and re-presented section.
  5. First published.