Supraventricular Arrhythmias

Supraventricular arrhythmias fall into two main categories: supraventricular tachycardia (SVT) and atrial fibrillation.

Supraventricular tachycardia

SVT is a common arrhythmia that is usually not considered a risk for sudden death. On occasion, SVT can cause loss of consciousness or compromise cerebral function. Treatment by catheter ablation is usually curative and allows drug therapy to be withdrawn.

Atrial fibrillation

The major risk associated with atrial fibrillation is the presence of an embolus which can cause a stroke. Anticoagulant therapy decreases the risk of peripheral embolization in individuals with risk factors for stroke.

See the Supraventricular Tachycardias Recommendation Table (PDF) for diagnosis-specific recommendations. The following are general recommendations.

Waiting period

Minimum — 1 month anticoagulated adequately and diagnosis is atrial fibrillation

• As cause of stroke or risk for stroke.
• Following thoracic surgery.

Minimum — 1 month post-isthmus ablation and diagnosis is atrial flutter

Minimum — 1 month asymptomatic/treated asymptomatic and diagnosis is:

• Atrioventricular nodal reentrant tachycardia.
• Atrioventricular reentrant tachycardia and Wolff-Parkinson-White syndrome.
• Atrial tachycardia.
• Junctional tachycardia.

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver has:

• Heart rate that is controlled.
• Treatment for prevention of emboli that is effective and tolerated.
• No underlying disease that is disqualifying.
• Clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.

Recommend not to certify if:

The condition causes:

• Loss of consciousness.
• Compromised cerebral function.
• Sudden death resuscitation.

Monitoring/Testing

The driver should:

• Comply with anticoagulant therapy guidelines, when appropriate.
• Have annual evaluation by a cardiovascular specialist who understands the functions and demands of commercial driving.

Follow-up

The driver should have an annual medical examination.

There are times when the medical assessment and the guidelines may yield different conclusions about the severity of the condition. A driver could have a benign underlying medical problem with an excellent prognosis but still not be medically qualified as a commercial driver. For example, if a benign supraventricular arrhythmia causes syncope, the driver cannot be medically certified until the problem has been corrected.