2 Cardiovascular Disorders - DVLA Assessing Fitness to Drive Guide

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

DVLA logo

The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.

Advice for medical professionals for drivers with cardiovascular disorders.

X - 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
AnginaX- 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.

X- Must not drive and must notify the DVLA when symptoms occur.

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

Driving may be relicensed (provided there is no other disqualifying condition) if:

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

Acute coronary syndromes (ACS)

Acute coronary syndromes are defined as follows:

  • unstable angina (symptoms at rest, with ECG changes)
  • non-ST elevation MI with at least two of the following three
    1. symptoms at rest
    2. raised serum troponin
    3. ECG changes
  • STEMI symptoms, with ST elevation on ECG.
Group 1
car and motorcycle
Group 2
bus and lorry
X- Must not drive but need not notify the DVLA.

Driving may resume 1 week after successful coronary angioplasty and if:

♦ no other urgent revascularization 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 no successful coronary angioplasty, driving may resume only after 4 weeks from acute event, provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA – for all ACSs.

Licence will be refused or revoked.

Driving may be relicensed after at least 6 weeks and if:

♦ the requirements for exercise or other functional tests can be met (see Appendix C)
♦ there is no other disqualifying condition.

Percutaneous coronary intervention (PCI) – elective angioplasty with or without stent

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

Driving may resume after at least 1 week provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Driving may be relicensed after at least 6 weeks and if:

♦ 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
X- Must not drive but need not notify the DVLA.

Driving may resume after at least 4 weeks provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Driving may be relicensed after at least 3 months and if:

♦ no evidence of significant left ventricular impairment – LV ejection fraction is at least 40%
♦ the requirements for exercise or other functional tests can be met (see Appendix C), also 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 likely to cause incapacityX- Must not drive and may need to notify the DVLA.

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.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked. Driving may be relicensed (provided there is no other disqualifying condition) only after:

♦ underlying cause has been identified
♦ arrhythmia has been controlled for at least 3 months
♦ no evidence of significant left ventricular impairment – 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 incapacityX- Must not drive but need not notify the DVLA.

Driving may resume after at least 2 days provided there is no other disqualifying condition.

X- Must not drive but need not notify the DVLA.

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

For arrhythmia not causing or likely to cause incapacityX- Must not drive but need not notify the DVLA.

Driving may resume after at least 2 days provided there is no other disqualifying condition.

X- Must not drive 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
X- Must not drive but need not notify the DVLA.

Driving may resume after 1 week provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

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

Unpaced congenital complete heart block

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

Licence will be refused or revoked permanently.

SymptomaticX- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Atrial defibrillator

 Group 1
car and motorcycle
Group 2
bus and lorry
Physician or patient activated! - May drive provided there is no other disqualifying condition. Must notify the DVLA.X- Must not drive and must notify the DVLA.

Driving may be relicensed (provided there is no other disqualifying condition) after the arrhythmia requirements have been met (see Appendix C).

Automatic! - May drive provided there is no other disqualifying condition. Must notify the DVLA.

Note: also refer to the implantable cardioverter defibrillator (ICD) requirements below.

X-Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Implantable cardioverter defibrillator (ICD)

Group 1 car and lorry drivers

In all cases of ICD 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.

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.
 Group 1
Car and motorcycle
Group 2
Bus and lorry
ICD for sustained ventricular arrhythmia associated with incapacity
Without further sequelaeX- Must not drive and may need to notify the DVLA.

Driving may resume after 6 months from a first implant – except that any of the sequelae 1-4 below require further specific restrictions and may require notification to the DVLA.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

1. With any shock therapy and/or pacing for symptomatic tachycardiaX- Must not drive and must notify the DVLA.

Must not drive for a further 6 months from the time of any shock therapy or pacing for symptomatic tachycardia.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

2. With incapacity following implantation or therapy (whether caused by device or arrhythmia)X- Must not drive and may need to notify the DVLA.

Must not drive for 2 years after symptoms of incapacity and must notify the DVLA.

Exceptions to this 2 year requirement apply as follows, but the minimum initial restriction after implantation still applies (i.e. must not drive for 6 months).

1. If therapy delivery was due to an inappropriate cause such as atrial fibrillation or, for example, programming issues:
♦ driving may resume 1 month after complete control of any cause to the satisfaction of the cardiologist.

2. If therapy delivery was 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 provided there is an absence of further symptomatic therapy.

X- 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 treatmentX- Must not drive but need not notify the DVLA.

Driving may resume 1 month after electrode revision or drug alteration.
The minimum initial restriction after implantation still applies (must not drive for 6 months).

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

4. With defibrillator box changeX- Must not drive but need not notify the DVLA.

Driving may resume 1 week after box change.

The minimum initial restriction after implantation still applies (must not drive for 6 months).

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

ICD for sustained ventricular arrhythmia not associated with incapacity
 X- Must not drive for 1 month and may need to notify the DVLA.

Driving may resume 1 month after implantation and the DVLA need not be notified, provided:

♦ presentation was a ‘non-disqualifying’ cardiac event – i.e. haemodynamically stable sustained ventricular tachycardia without incapacity
♦ LV ejection fraction is greater than 35%
♦ no fast ventricular tachycardia (VT) induced on electrophysiological study – i.e. RR interval of less than 250 milliseconds
♦ during the postimplantation study, any induced VT could be paceterminated by the ICD twice, without acceleration.

Note: should ICD subsequently deliver anti-tachycardia pacing and/or shock therapy (except during normal clinical testing), the DVLA must be notified and the restrictions must be applied as for sustained ventricular arrhythmia associated with incapacity).

X- 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 arrhythmiaX- Must not drive and must notify the DVLA:

♦ driving may resume 1 month after implantation (need not notify the DVLA if remains asymptomatic and no ICD therapy needed)
♦ should the ICD subsequently deliver anti-tachycardia pacing and/ or shock therapy (except during normal clinical testing), the DVLA must be notified and the restrictions must be noted as for sustained ventricular arrhythmia associated with incapacity)
♦ need not notify the DVLA if remains asymptomatic and no ICD therapy needed.

Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Aortic aneurysm – ascending or descending thoracic and/or abdominal

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.

! - 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.

X- Must not drive and must notify the DVLA if the aneurysm diameter is 5.5 cm or greater.

Licence will be refused or revoked.

May be relicensed 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 case of abdominal aortic aneurysm.

X- 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 after successful surgical treatment without evidence of further enlargement and no other disqualifying condition.

X- Must not drive and must notify the DVLA if the aneurysm diameter is 5.5 cm or greater.

Licence will be refused or revoked.

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

For surgically treated abdominal aortic aneurysm the exercise or other functional test requirements will need to be met.

Thoracic aortic aneurysm with bicuspid aortopathy

Group 1 
car and motorcycle
Group 2 
bus and lorry

! - May drive but must notify the DVLA.

With bicuspid aortopathy, maximum aortic diameter should be less than 6.5 cm.

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

X- May drive and need not notify the DVLA as long as the conditions below are met.

With bicuspid aortopathy, maximum aortic diameter should be less than 5.5 cm provided:

♦ there is no associated coarctation of aorta
♦ there is no systemic hypertension
♦ there is no family history of dissection
♦ growth is not greater than 3 mm per year.

If any of the above apply, the maximum aortic diameter allowed would be less than 5 cm.

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
X - Must not drive and must notify the DVLA.

If aortic diameter exceeds 6 cm driving may resume after 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.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Driving may be relicensed only after all the following are met:

♦ if chronic aortic dissection maximum transverse diameter of the aorta is less than 5.5 cm (including the false lumen)
♦ complete thrombosis of the false lumen
♦ surgical intervention and/or satisfactory medical therapy (blood pressure well controlled)
♦ medical follow up in place
♦ satisfactory surgical intervention and/or
♦ satisfactory medical therapy (blood pressure well controlled).

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 aneurysm, see above for the restrictions under aortic aneurysm.

X- Must not drive and must notify the DVLA.

Driving may be relicensed only if:

♦ standards are met for aortic aneurysm (see above)
♦ satisfactory medical treatment
♦ annual review (including aortic root measurement) by a cardiologist or related specialist.

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.

Driving may be relicensed 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:

X- Must not drive if treatment for any level of hypertension causes side-effects that affect or are likely to affect safe driving (but need not notify the DVLA).

! - May drive and need not notify the DVLA, except:

X- 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.

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

Cardiomyopathies

The DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction <40%.

Also refer to the following sections in this document:

 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.

X- Must not drive and must notify the DVLA.

Driving may be relicensed only after at least a 25 mm Hg increase in systolic blood pressure during exercise testing (testing to be repeated every 3 years) has been demonstrated and at least two of the following three criteria are met:

1. no first-degree family history of sudden premature death from presumed HCM

2. HCM not anatomically severe – wall thickness no greater than 3 cm confirmed by cardiologist

3. no serious abnormality of heart rhythm such as non-sustained ventricular tachycardia (NSVT).

See Appendix C

Symptomatic√- May drive and need not notify the DVLA.

There must be no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

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.

There must be no other disqualifying condition.

Symptomatic√- May drive and need not notify the DVLA.

There must be no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Driving may be relicensed if there is no other disqualifying condition.

Arrhythmogenic right ventricular cardiomyopathy – and allied disorders
Asymptomatic√- May drive and need not notify the DVLA.X- Must not drive and must notify the DVLA.

Driving may be relicensed following specialist electrophysiological assessment, provided there is no other disqualifying condition.

Symptomatic X- Must not drive and must notify the DVLA if arrhythmia has caused or is likely to cause incapacity.

Driving may be relicensed once arrhythmia is controlled, provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Re-licensing 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 3 year license may be considered if the specialist electrophysiological review is satisfactory.

Heart failure

 Group 1
car and motorcycle
Group 2
bus and lorry
Asymptomatic√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
SymptomaticX- Must not drive if there are symptoms likely to distract the driver or otherwise affect safe driving but need not notify the DVLA.X- Must not drive and must notify the DVLA.

Licence will be refused or revoked.

Relicensing would require:

♦ LV ejection fraction at least 40%
♦ no other disqualifying condition.

Depending on likely cause for heart failure, exercise or other functional testing may be required (see Appendix C).

Left ventricular assist device implantedX- Must not drive but need not notify the DVLA.

Driving may be relicensed under individual assessment only after 3 months from implantation.

X- Must not drive and must notify the DVLA.

Licence will be refused or revoked permanently.

Cardiac resynchronisation therapy (CRT)

 Group 1
car and motorcycle
Group 2
bus and lorry
CRT pacemakerX- Must not drive and must notify the DVLA.

Driving may resume after at least 1 month from implantation if:

♦ there are no symptoms likely to affect safe driving
♦ there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

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

♦ the requirements under heart failure (see above) are met
♦ there is no other disqualifying condition.

CRT defibrillator! - May drive subject to following provisions but must notify the DVLA.

Provisions:

♦ the requirements under implantable cardioverter defribillator (ICD) are met
♦ there is no other disqualifying condition.

X- 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
X- Must not drive for at least 6 weeks after surgery.

Need not notify the DVLA.

There must be no other disqualifying condition.

X- Must not drive for at least 3 months following surgery and must notify the DVLA.

Driving may be relicensed provided:

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

Heart valve disease

Note:

 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√- May drive and need not notify the DVLA.

There must be no other disqualifying condition.

X- Must not drive and must notify the DVLA.

If there is no other disqualifying condition and once free of symptoms, driving may be relicensed.

If there is cerebral embolism, relicensing may be after 12 months and following specialist assessment required by the DVLA to determine fitness.

Aortic stenosis

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

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

♦ the exercise tolerance test requirements from the DVLA 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 are ECG changes
♦ a cardiologist considers that exercise testing would be unsafe for the individual
♦ a test is not possible for any other reason.

SymptomaticX- Must not drive and must notify the DVLA.

Licence will be refused or revoked pending assessment and treatment.

X- 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

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

Driving may resume only after at least 4 weeks, provided there is no other disqualifying condition.

X- Must not drive and must notify the DVLA.

Driving may be relicensed only after at least 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 completely 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 repair of defects or relief of valvular problems, fistulae, and so on
♦ no other disqualifying condition.

Symptomatic

X- Must not drive and must notify the DVLA.

Symptoms include angina, arrhythmias/palpitations, dyspnoea, uncontrolled hypertension, symptomatic heart failure, symptomatic 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 fall under any other category which requires notification to the DVLA.

Individual assessment of symptomatic cases. Certain conditions may require a medical review licence to be issued for 1, 2, or 3 years.

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.

X- Must not drive and 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 repair of defects or relief of valvular problems, fistulae, and so on
♦ 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.

X- Must not drive and must notify the DVLA.

Driving may be relicensed only after at least 3 months, 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.

Driving may be relicensed 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.

© Crown copyright. Reproduced under the terms of the Open Government Licence.

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Author:
DVLA
Peer Reviewer:
DVLA
Document ID:
13195 (v7)
Last Checked:
07 March 2017

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.