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.................................................................................................... or without syncope, while <2% of cases of reported sudden driver incapacitation have resulted in injury or death to bystanders, or other road users.579

In 2013, a Working Group of the ESC published detailed recommendations on driving restriction in patients with SVT (Table 14).580 Two groups of drivers are considered. Group 1 comprises drivers of motorcycles, cars, and other small vehicles with and without a trailer. Group 2 includes drivers of vehicles over 3500 kg or passengercarrying vehicles exceeding eight seats excluding the driver. Drivers of taxicabs, small ambulances, and other vehicles form an intermediate category between the ordinary private driver and the vocational driver.

18 Key messages

• Not all SVTs are arrhythmias of the young. • Vagal manoeuvres and adenosine are the treatments of choice for the acute therapy of SVT, and may also provide important diagnostic information. • Verapamil is not recommended in wide QRS-complex tachycardia of unknown aetiology. • Consider using ivabradine, when indicated, together with a betablocker. • In all re-entrant and most focal arrhythmias, catheter ablation should be offered as an initial choice to patients, after having explained in detail the potential risks and benefits. • Patients with macro-re-entrant tachycardias following atrial surgery should be referred to specialized centres for ablation. • In post-AF ablation ATs, focal or macro-re-entrant, ablation should be deferred for >_3 months after AF ablation, when possible. • Ablate AVNRT, typical or atypical, with lesions in the anatomical area of the nodal extensions, either from the right or left septum. • AVNRT, typical or atypical, can now be ablated with almost no risk of AV block. • Do not use sotalol in patients with SVT. • Do not use flecainide or propafenone in patients with LBBB, or ischaemic or structural heart disease. • Do not use amiodarone in pre-excited AF. • One in five patients with asymptomatic pre-excitation will develop an arrhythmia related to their AP during follow-up. • The risk of cardiac arrest/ventricular fibrillation in a patient with asymptomatic pre-excitation is 2.4 per 1000 person-years. • Non-invasive screening may be used for risk stratification of patients with asymptomatic pre-excitation, but its predictive ability remains modest. • Invasive assessment with an EPS is recommended in patients with asymptomatic pre-excitation who either have high-risk occupations or are competitive athletes. • If a patient undergoes assessment with an EPS and is found to have an AP with ‘high-risk’ characteristics, catheter ablation should be performed. • If possible, avoid all antiarrhythmic drugs during the first trimester of pregnancy. If beta-blockers are necessary, use only beta-1 selective agents (but not atenolol). • If ablation is necessary during pregnancy, use non-fluoroscopic mapping. • Consider TCM in patients with reduced LV function and SVT. • Ablation is the treatment of choice for TCM due to SVT. AV nodal ablation with subsequent biventricular or His-bundle pacing (‘ablate and pace’) should be considered if the SVT cannot be ablated.

19 Gaps in the evidence

• The distinction between triggered activity and enhanced automaticity is not straightforward, as the two mechanisms share many similar responses and characteristics, such as enhancement by

Table 14 European Working Group 2013 report on driving and cardiovascular disease: driving in arrhythmias and conduction disorders: supraventricular tachycardia

Conduction disorder/ arrhythmia Group 1 Group 2 AF/atrial flutter/focal AT Driving may continue provided no history of syncope. If history of syncope, driving must cease until the con-

dition has been satisfactorily controlled/treated. Driving may continue provided no history of syncope and

anticoagulation guidelines are adhered to. If history of syncope, driving must cease unless the under-

lying cause is treated and the risk of recurrence is low. Rate control during tachycardia should be adequate. Driving can only be resumed after medical assessment.

AVNRT, AVRT, and WPW If history of syncope, driving must cease until the con-

dition has been satisfactorily controlled/treated. Driving may continue provided no history of syncope or

other significant symptoms (e.g. palpitations with dizziness). If so, driving must cease until the underlying cause is treated so that the risk of recurrence is low. In case of pre-excitation, driving may only be allowed after

specialist assessment.

AF = atrial fibrillation; AT = atrial tachycardia; AVNRT = atrioventricular nodal re-entrant tachycardia; AVRT = atrioventricular re-entrant tachycardia; WPW = Wolff-Parkinson-White. Downloaded from academic.oup.com/eurheartj/article/41/5/655/5556821 by guest on 07 October 2026