Syncope While Driving

Sorajja, Dan; Nesbitt, Gillian C.; Hodge, David O.; Low, Phillip A.; Hammill, Stephen C.; Gersh, Bernard J.; Shen, Win Kuang

doi:10.1161/circulationaha.108.827626

Cited by 71 publications

(28 citation statements)

References 42 publications

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“…Sorajja et al reported that among subjects evaluated for syncope from 1996 to 1998 at Mayo Clinic, 9.8% had at least one syncopal episode while driving. 4 For pilots in high performance aircraft, the high gravity force during training/duty pools blood to the lower body resulting in cerebral hypoperfusion and hypoxia, which may lead to syncope. According to Carter et al, up to 48% of the United State Air Force population has experienced syncope.…”

Section: Introductionmentioning

confidence: 99%

Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

et al. 2014

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Abstract. Significant drops in arterial blood pressure and cerebral hemodynamics have been previously observed during vasovagal syncope (VVS). Continuous and simultaneous monitoring of these physiological variables during VVS is rare, but critical for determining which variable is the most sensitive parameter to predict VVS. The present study used a novel custom-designed diffuse correlation spectroscopy flow-oximeter and a finger plethysmograph to simultaneously monitor relative changes of cerebral blood flow (rCBF), cerebral oxygenation (i.e., oxygenated/deoxygenated/total hemoglobin concentration: r½HbO 2 ∕r½Hb∕rTHC), and mean arterial pressure (rMAP) during 70 deg head-up tilt (HUT) in 14 healthy adults. Six subjects developed presyncope during HUT. Two-stage physiological responses during HUT were observed in the presyncopal group: slow and small changes in measured variables (i.e., Stage I), followed by rapid and dramatic decreases in rMAP, rCBF, r½HbO 2 , and rTHC (i.e., Stage II). Compared to other physiological variables, rCBF reached its breakpoint between the two stages earliest and had the largest decrease (76 AE 8%) during presyncope. Our results suggest that rCBF has the best sensitivity for the assessment of VVS. Most importantly, a threshold of ∼50% rCBF decline completely separated the subjects from those without presyncope, suggesting its potential for predicting VVS.

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Section: Introductionmentioning

confidence: 99%

Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

et al. 2014

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“…The causes of syncope, the late recurrences of syncope (during Ͼ6 months of follow-up), and the overall low incidence of recurrent syncope while driving provide useful information to supplement current recommendations on driving for these patients. 4 Summary: Brugada syndrome is characterized by ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death. Fundamental questions remain on the best strategy for assessing the real disease-associated arrhythmic risk, especially in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Circulation: Arrhythmia and Electrophysiology Editors' Picks

2011

Circ: Arrhythmia and Electrophysiology

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The following articles are being highlighted as part of Circulation: Arrhythmia and Electrophysiology's Topic Review series. This series will summarize the most important manuscripts, as selected by the editors, published in Circulation: Arrhythmia and Electrophysiology and the rest of the Circulation portfolio. The studies included in this article represent the most read manuscripts published on the topic of atrial fibrillation in . (Circ Arrhythm Electrophysiol. 20114:e76-e83 76 (2005 and 2006), with an average of 66 per year (range, 50 -76) over the last 6 years, many of which could not have been identified reliably by preparticipation screening (even with an ECG); 29% of deaths were among blacks, 54% of victims were in high school, 82% of the deaths occurred with physical exertion during competition/training, and only 11% were female. The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was relatively low, with a rate of Ͻ100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and suggest the need for systematic and mandatory reporting of sudden deaths in athletes to a national registry. Conclusions:In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of Ͻ100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry. 1 Summary: In patients with hypertrophic cardiomyopathy, syncope can be neurally mediated or a warning of dangerous arrhythmias or hemodynamic impairment, but its prognostic significance is not clearly established. We assessed the relationship between syncope and sudden death in 1511 consecutive hypertrophic cardiomyopathy patients; 205 (14%) had a history of unexplained or neurally mediated syncope. Over a 5.6-year mean follow-up, 74 patients died suddenly. Unexplained syncope but not neurally mediated syncope was associated with an increased risk of sudden death (hazard ratio, 1.78, Pϭ0.08 compared with patients without syncope). Temporal proximity of unexplained syncope to initial patient evaluation was important. Patients with recent unexplained syncope (Յ6 months before initial evaluation) showed a 5-fold increase in risk compared with patients without syncope, a relationship that was maintained throughout all age groups. In adolescents, unexplained syncope was associated with a 60% cumulative risk at 5 years. Older patients (Ն40 years) with remote syncope (Ͼ5 years before initial evaluation) showed no increased sudden death risk. Thus, unexplained syncope is a marker for increased risk in hypertrophic cardiomyopathy, particularly when it occurs in close tempor...

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“…For occupational drivers, we used the value of 0.02 that was set in the study of the Canadian Cardiovascular Society as the estimated maximal probability that sudden death by syncope results in a fatal or injuryproducing accident [16][17][18][19][20]. While it was difficult to find any associated data that directly provided the Ac for PWE, disease-specific risks for fatal crashes associated with seizures and other medical conditions were compared in a previous study in the United States [21].…”

Section: Estimation Of the Risk Of Fatal Traffic Accidentmentioning

confidence: 99%

Estimating the risk of fatal traffic accidents posed by drivers with epilepsy in Japan: A comparison with traffic accidents caused by sudden death of occupational drivers

Ban

Kawai

Nambu

et al. 2018

E&S

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Purpose: Pr oper judgement of the aptitude of people with epilepsy (PWE) for dr iving is a cr itical issue, both medically and socially. One thus far reported approach is a quantitative comparison of the risk of fatal traffic accidents caused by PWE drivers and that by subgroups of drivers in the general population. We propose a new approach that compares the risk posed by PWE drivers and that by sudden death of occupational drivers, and the maximum driving time for PWE based on that comparison. Method: The r isk of fatal tr affic accidents was estimated using four var iables. The value assigned to each variable was determined using reports and statistics. Results: The r isk of fatal tr affic accidents caused by sudden death of occupational dr iver s was estimated to be 7.6×10 -5 /year, 4.9×10 -5 /year, and 1.7×10 -5 /year for large-sized, mid-sized and normalsized vehicles. The risk of fatal traffic accidents caused by PWE drivers was estimated to be 5.3×10 -5 / year and 3.2×10 -5 /year for PWE with seizure-free periods of 1 year and 2 years, respectively. The maximum acceptable driving time for PWE having a 2-year seizure-free period at the equivalent risk caused by sudden death of occupational drivers of mid-sized vehicles was estimated to be 304 min/week. Conclusion: The r isk of fatal tr affic accidents caused by PWE dr iver s can be evaluated by comparing to that caused by sudden death of occupational drivers. Such risk posed by PWE drivers having a 2-year seizure-free period was less than that caused by sudden death of occupational drivers of midsized vehicles. Assuming that the society accepts the latter risk, PWE may be permitted to drive for an estimated maximum time at the equivalent risk of causing a fatal accident.

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Syncope While Driving

Cited by 71 publications

References 42 publications

Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

Circulation: Arrhythmia and Electrophysiology Editors' Picks

Estimating the risk of fatal traffic accidents posed by drivers with epilepsy in Japan: A comparison with traffic accidents caused by sudden death of occupational drivers

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