[Syncope and fitness to drive]

Although medical students are rarely instructed in traffic medicine in Germany, they are obliged to inform their patients about their fitness to drive after having become a medical doctor. This article gives an overview on the fitness to drive for patients with syncope by referring to the driving license regulation and the current guidelines released by the department of traffic. The driving license regulation distinguishes between group 1 and group 2 drivers. Group 1 drivers drive vehicles with a total weight less than 3.5 t, whereas group 2 drivers drive vehicles with a total weight above 3.5 t or provide commercial passenger transport. Since patients with syncope may suffer from different serious illnesses, the first approach is to clarify the cause of syncope. If no treatable cause of syncope (e. g., pacemaker, aortic valve replacement) is found, drivers of group 1 are not fit to drive for 6 months after a second unexplained syncope, whereas in this situation, drivers of group 2 are not fit to drive permanently. If, however, syncopes occur in conditions which cannot be expected to occur while driving (e. g. venipuncture, defecation, micturition) fitness to drive will persist. Syncope due to ventricular tachycardia in ischemic heart disease and reduced left ventricular ejection fraction are in general treated with an implantable cardioverter-defibrillator (ICD). Group 2 drivers with an ICD are normally unfit to drive. Group 1 drivers with an ICD are fit to drive when no syncope or adequate shock occurred within the last three months.