✘- Must not drive

! - May continue to drive subject to medical advice and/or notifying DVLA

✓- May continue to drive and need not notify DVLA

Angina - to include INOCA (ischaemia with non-obstructive arteries)

	Group 1 car and motorcycle	Group 2 bus and lorry
Angina	✘- Must not drive when symptoms occur: ■ at rest ■ with emotion ■ at the wheel. Driving may resume after satisfactory symptom control. Need not notify DVLA.	✘- Must notify DVLA. Must not drive when symptoms occur A licence will be refused or revoked if symptoms continue (treated or untreated). May be relicensed/licensed (provided there is no other disqualifying condition) if: ■ no angina for at least 6 weeks ■ the requirements for exercise or other functional tests can be met (see Appendix C)

Acute coronary syndrome (ACS) - to include type 1 and type 2 myocardial infarction, MINOCA (myocardial infarction with non-obstructive coronary arteries) and Takotsubo cardiomyopathy

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - Must not drive but need not notify DVLA. Driving may resume 1 week after ACS if successful coronary intervention (PCI) has been carried out and if all of the following are met: ■ no other urgent revascularisation 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 not treated by successful coronary intervention or any of the above are not met, driving may resume only after 4 weeks from the acute event, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA – for all ACS. Licence will be refused or revoked. May be relicensed/licensed after at least 6 weeks if: ■ LV ejection fraction is at least 40% ■ the requirements for exercise or other functional tests can be met (see Appendix C) ■ there is no other disqualifying condition No functional cardiac test is required in Takotsubo cardiomyopathy in the absence of known coronary artery disease

Elective percutaneous coronary intervention (PCI)

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive for at least 1 week but need not notify DVLA. Driving may resume after 1 week provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after at least 6 weeks if: ■ LV ejection fraction is at least 40% ■ 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
	✘- Must not drive for at least 4 weeks but need not notify DVLA. Driving may resume after 4 weeks provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after 3 months if: ■ LV ejection fraction is at least 40% ■ the requirements for exercise or other functional tests can be met (see Appendix C), at least 3 months postoperatively ■ there is no other disqualifying condition

Coronary artery disease

For Group 2 licensing, if there is evidence of obstructive coronary artery disease on invasive or CT angiography or myocardial ischaemia on functional testing but it does not fall under any of the categories above, those individuals would need to meet the functional test requirements.

Spontaneous coronary artery dissection (SCAD)

	Group 1 car and motorcycle	Group 2 bus and lorry
	! -  Must not drive but need not notify DVLA. Driving may resume 4 weeks after recovery from the acute event, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused/revoked. Relicensing will be considered upon individual assessment.

Transient loss of consciousness (‘blackouts’) – or lost or altered awareness – including blackouts with seizure markers and cough syncope

Refer to Appendix D.

Arrhythmias

Arrhythmias include:

• sinoatrial disease
  
• significant atrioventricular conduction defect
  
• atrial flutter/fibrillation
  flutter or fibrillation
• narrow or broad complex tachycardia
  

Note:

• ifIf a transient arrhythmia occurs during an acute coronary syndrome, the guidance relating to ACS takes precedence
  
• pacemakersprecedence.

  Should a ventricular arrhythmia result in either a clinical indication or clinical recommendation for ICD implant, then a period of 6 months will be required off Group 1 driving (following the date of the last arrhythmic episode or the date of ICD implant). A Group 2 licence will be permanently revoked, even if implantation does not occur.

  Pacemakers are considered separately.
  

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
Arrhythmia	✘- Must not drive for at least 4 weeks if arrhythmia has caused or is likely to cause incapacity. Driving may resume without4 DVLAweeks notificationafter onlyan after:incapacitating event if: ■ underlyingthe cause of the event has been identified ■ arrhythmiaand is controlled for at least 4 weekstreated ■ Must notify DVLA if there areis symptomsno thatrecurrence areof arrhythmia likely to cause incapacity Driving and/orshould not resume until the arrhythmiaabove iscriteria notare controlledmet for at least 4 weeks,weeks andfrom anthe underlyinglast causearrhythmic hasevent, notand beenDVLA identified.must be notified. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.	✘- Must notify DVLA. Must not drive if arrhythmia has caused or is likely to cause incapacity. Licence will be refused or revoked. May be relicensed/licensedrelicensed or licensed (provided there is no other disqualifying condition) only after:if: ■ the underlying cause has been identified and treated ■ no further arrhythmia hasis beenlikely controlledto cause incapacity for at least 3 months ■ the LV ejection fraction is at least 40% For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Successful catheter ablation

	Group 1 car and motorcycle	Group 2 bus and lorry
For VT ablation with impaired ventricular function (right or left) or congenital heart disease (corrected or not)	✘- Must not drive for at least 4 weeks but need not notify DVLA. Driving may resume after 4 weeks provided there is no other disqualifying condition and arrhythmia has been controlled.	✘- Must not drive and must notify DVLA. May be relicensed/licensed (provided there is no other disqualifying condition) only after arrhythmia has been controlled for at least 3 months and LVEF at least 40%.
For other ablations	✘- Must not drive for at least 2 days but need not notify DVLA. Driving may resume after 2 days provided there is no other disqualifying condition.	✘- Must not drive for at least 2 weeks but need not notify DVLA. Driving may resume after 2 weeks provided there is no other disqualifying condition and LVEF at least 40%.

Pacemaker implant – including box change

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
	✘- Must not drive for at least 1one week after pacemaker implant and pacemaker box change. Must notify DVLA of pacemaker implantation. Need not notify DVLA of pacemaker box change. Driving may resume after 1one week provided there is no other disqualifying condition. Regular device checks must be undertaken with your specialist health care professional.	✘- ✘-  Must not drive for at least 6 weeks and must notify DVLA. Must notify DVLA of pacemaker implantation. Need not notify DVLA of pacemaker box change. Driving may resume after 6 weeks provided there is no other disqualifying condition. Regular device checks must be undertaken with your specialist health care professional.

Congenital complete heart block

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently until pacemaker implanted.
Symptomatic	✘- Must not drive and must notify DVLA. Licence will be refused or revoked until pacemaker implanted.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently until pacemaker implanted.

Implantable cardioverter defibrillator (ICD)

Group 1 car and lorrymotorcycle drivers

In all cases of ICD implanted 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
• all the requirements as below mustbeing be met

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:

• DVLA must be notified
• the licence will be refused or revoked permanently

ICD implanted for sustained ventricular arrhythmia associated(secondary with incapacityprevention)

For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Without further sequelae	✘- Must not drive and must notify DVLA. Driving may resume after 6 months following implantationimplantation, –unless except that any of the sequelae 1-41-3 below require further specific restrictions andor may require notification to DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
1.If either or both of the below are true 1a. With any shock therapy,therapy 1b. and/orWith any anti-tachycardia pacing associated with incapacity or likely to cause incapacity (whether incapacity is caused by the device or arrhythmia)	✘- If therapy delivery was due to an inappropriate cause such as atrial fibrillation or programming issuesissues, driving may resume 1one month after complete control of any cause to the satisfaction of the cardiologist, and DVLA need not be notified. If therapy delivery was appropriate due to sustained ventricular tachycardia or ventricular fibrillation, DVLA must benot notifieddrive and drivingmust notify DVLA.  Driving may resume 6 monthsmonths after after the eventmost provided:recent ■appropriate preventive steps against recurrence have been taken with anti-arrhythmic drugs, an ablation procedure, or ICD programming alteration and ■ there is an absence of further shock therapy and/or(as anti-tachycardiain pacing1a associated with incapacity or likely to cause incapacity. Otherwise, must not drive for 2 years and must notify DVLA.1b).	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
2. With any revision of electrodes or anti-arrhythmic drug treatment	✘- Must not drive for 1one month but need not notify DVLA. Driving may resume 1one month after electrode revision or drug alteration provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.
3. With defibrillator box change	✘- Must not drive for 1one week but need not notify DVLA. Driving may resume 1one week after box change provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

Prophylactic ICD implanted(primary for sustained ventricular arrhythmia not associated with incapacityprevention)

	Group For 1 Car and motorcycle	Group 2 Buslicensing, andshould lorry
	!ICD - Must not drive for 1 month following implantation andbe mustrecommended notify(based DVLA. Drivingupon mayclinical resumeguidance 1or monthexpert afteropinion), but implantation provideddoes allnot ofoccur theor following are met: ■ presentation was a ‘non-disqualifying’ cardiac event – i.e. haemodynamically stable sustained ventricular tachycardia without incapacity ■ LV ejection fraction is greaterdeclined thanby 35% ■the anydriver, VTthen induced on electrophysiological study has RR interval greater than 250 milliseconds ■ during the post-implantationdriver electrophysiologicalor study,applicant anywill induced VT could be pace-terminatedassessed byagainst the ICD twice,standard. withoutThis acceleration Ifmeans any of the abovelicence notwill met,be mustrefused notor driverevoked forpermanently. For 6the monthspurposes followingof implantation. Note:this shouldguidance ICD‘incapacity’ subsequentlyis deliverdefined shockas therapyany and/orcondition, anti-tachycardiasymptom pacingor associatedtreatment withthat oris likely to cause incapacityan (exceptindividual duringto normal clinical testing), DVLA must be notifiedunable andto thesafely relevantcontrol restrictions must be applied as detailed under the heading ICD implanted for sustained ventricular arrhythmia associated with incapacity).	✘- Must not drive and must notify DVLA. Licence will be refused or revokedstop permanently.

Prophylactica ICD

vehicle.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
In asymptomatic individuals with a high risk of significant arrhythmia	✘- Must not drive for 1one month following implantation and must notify DVLA:DVLA. ■Driving driving may resume 1one month after implantation if the individual remains asymptomatic and no ICD therapy neededis needed. Must ■not drive and must notify DVLA should the ICD subsequently deliver shock therapy and/oror anti-tachycardia pacing associated with or likely to cause incapacity (except during normal clinical testing),testing). DVLAThe must be notified and relevant restrictions must be applied as detailed under the heading ‘ICD implanted for sustained ventricular arrhythmia associated(secondary with incapacity) For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.prevention)’.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Aortic aneurysm – ascending or descending thoracic and/oraorta (which includes the aortic arch) or abdominal

All patients must have regular medical review.

Note:For for Group 2 cases, the exercise or other functional test requirements will need to be met in all cases of abdominalaortic aneurysm – ascending or descending thoracic aorta (which includes the aortic aneurysm.arch) or abdominal.

Aortic aneurysm (see separate standards for people with bicuspid aortopathy or Marfan syndrome)

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
Aortic aneurysm (see separate standards for people with bicuspid aortopathy or Marfan’s syndrome)	! - May drive and need not notify DVLA if aneurysm diameter is less than 66cm cm and there is no other disqualifying condition.	! - May drive if the aneurysm diameter is 5.5 cm or less and there is no other disqualifying condition. Must notify DVLA.*
	! - May drive but must notify DVLA if aneurysm diameter is between 66cm cm and 6.46.4cm. cm. May be relicensed/licensedrelicensed or licensed subject to annual review of licence and if there is no other disqualifying condition.	✘- Must not drive and must notify DVLA if the aneurysm diameter is greater6.5cm thanor 5.5greater. cm. Licence will be refused or revoked. May be relicensed/licensedrelicensed or licensed after successful open surgical treatment. May be relicensed following successful Endovascular Aneurysm Repair (EVAR) or interventionalThoracic treatmentEndovascular ifAortic noRepair aortic(TEVAR). segmentRelicensing is greaterdependent thanupon 5.5cmcompliance with clinical review as advised by the treating clinician. Following endovascular repair individuals with an endoleak associated with a stable aneurysm sac diameter may be relicensed. Following endovascular repair individuals with an endoleak associated with an increase in aneurysm sac diameter may be relicensed dependent upon individual assessment. Following both open surgical repair and endovascular intervention there ismust be no other disqualifying condition.*condition (including no non-operated aneurysm segment exceeding acceptable threshold).
	! - May drive if the aneurysm diameter is 5.5cm or less and there is no other disqualifying condition. Must notify DVLA.* ✘- Must not drive and must notify DVLA if the aneurysm diameter is 6.5greater cmthan or greater.5.5cm. Licence will be refused or revoked. May be relicensed/licensedrelicensed or licensed after successful open surgical treatment. May be relicensed following successful Endovascular Aneurysm Repair (EVAR) or interventionalThoracic treatmentEndovascular ifAortic noRepair aortic(TEVAR). segmentRelicensing is greaterdependent thanupon 6.4compliance cmwith clinical review as advised by the treating clinician. Following endovascular repair individuals with an endoleak associated with a stable aneurysm sac diameter may be relicensed depending upon individual assessment. Following endovascular repair individuals with an endoleak associated with an increase in aneurysm sac diameter will not be licensed or relicensed. Following both open surgical repair and endovascular intervention there ismust be no other disqualifying condition.condition (including no non-operated  aneurysm segment exceeding acceptable threshold).*

*The exercise or other functional test requirements will need to be met in all cases of abdominal or descending thoracic or aortic arch aortic aneurysm.

Bicuspid aortopathy

Note: Assess risk factors for aortic dissection for all drivers with bicuspid aortopathy*

Group 1 car and motorcycle	Group 2 bus and lorry
! - May drive and need not notify DVLA if the ascending aortic diameter is less than 5.5cm (or 5.0cm with a risk factor for aortic dissection *) and there is no other disqualifying condition. ! - May drive but must notify DVLA if ascending aortic diameter is 5.5-6.4cm or greater (5.0-5.9 cm or greater with a risk factor for aortic dissection *) and there is no other disqualifying condition. ! - May be relicensed subject to annual review of licence and if there is no other disqualifying condition.	! - May drive and need not notify DVLA if the ascending aortic diameter is less than 4.0 cm and there is no other disqualifying condition. ! - May drive but must notify DVLA if the ascending aortic diameter is 4.0-5.5cm (4.0-5.0cm with a risk factor for aortic dissection *) and there is no other disqualifying condition. ! - May be relicensed/licensed subject to annual review of licence and if there is no other disqualifying condition.
✘- Must not drive and must notify DVLA if ascending aortic diameter is 6.5cm or greater (6.0cm or greater with a risk factor for aortic dissection *). Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and if there is no other disqualifying condition.	✘- Must not drive and must notify DVLA if ascending aortic diameter is 5.5cm or greater (5.0cm or greater with a risk factor for aortic dissection *). Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment without evidence of further enlargement and if there is no other disqualifying condition.

*Risk factors for dissection include:

• Coarctation of aorta

• Systemic hypertension

• Family history of dissection

• Documented increase in aortic diameter greater than 3mm/year

Aortic dissection

Note: ‘satisfactory control of blood pressure’ means clinically relevant to aortic dissection, not the DVLA standard for hypertension.

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
Type A	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment if: ■ aortic diameter including the false lumen is less than 6 cm ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow-up ■ no other disqualifying condition	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensed after successful surgical treatment if: ■ maximum transverse diameter of the aorta at any location is less than 5.5cm (including the false lumen) ■ complete thrombosis of the false lumen ■ satisfactory control of blood pressure and treatment adherence ■ satisfactory medical follow up ■ no other disqualifying condition
Type B	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensedrelicensed or licensed only after successful surgical or interventional treatment, or with medical treatment if: ■ aorticthe diameter (including the false lumen)lumen atof any locationaortic issegment) 6.0cmdoes not exceed 6cm or less ■ there’s satisfactory control of blood pressure and treatment adherence ■ there’s satisfactory medical follow-up ■ there’s no other disqualifying condition	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. May be relicensed/licensedrelicensed or licensed only after successful surgical or interventional treatment, or with medical treatment if: ■ aorticthe diameter (including the false lumen) atof any locationaortic issegment does not exceed 5.5cm or less ■ there’s complete thrombosis of the false lumen ■ there’s satisfactory control of blood pressure and treatment adherence ■ there’s satisfactory medical follow up ■ there’s no other disqualifying condition

Marfan syndrome and other inherited aortopathies

Note: Assess risk factors for aortic dissection for all drivers with Marfan syndrome*

	Group 1 car and motorcycle	Group 2 bus and lorry
Marfan Syndromesyndrome without risk factors*	✓- May drive and need not notify DVLA if no aneurysm. ✘- If there is an aortic aneurysm must notify DVLA and must not drive if the aortic diameter exceeds 5cm.	! - Must notify DVLA. Must not drive if: ■ maximum aortic diameter is greater than 5 cm ■ severe aortic regurgitation ■ any other disqualifying condition Licence will be revoked/refused.
Marfan Syndromesyndrome with risk factors*	✓- May drive and need not notify DVLA if no aneurysm. ✘- If there is an aortic aneurysm must notify DVLA and must not drive if the aortic diameter exceeds 4.5cm.	✘- Must notify DVLA. Must not drive if: ■ maximum aortic diameter is greater than 4.5 cm ■ severe aortic regurgitation ■ any other disqualifying condition Licence will be revoked/refused.
Marfan Syndromesyndrome and aortic surgery	✘- Must not drive and must notify DVLA. Driving may resume after successful surgical treatment (whether emergency or elective repair) and there is no other disqualifying condition.condition (including no non-operated aneurysm segment exceeding acceptable threshold).	✘- Debarred if emergency aortic surgery. Elective aortic surgery – individual assessment (see Appendix C for full details).
Other inherited aortopathies (for example, Loeys-Dietz syndrome, vascular type IV Ehlers-Danlos syndrome)	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Driving may resume if individual specialist assessment is favourable.

*Risk factors include:

• Family history of aortic dissection

• Severe aortic or mitral regurgitation

• Greater than 3mm per year increase than aneurysm diameter

• Pregnancy

Peripheral arterial disease

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓ - May drive and need not notify DVLA. There must be no other disqualifying condition.	! - May drive but must notify DVLA. May be relicensed/licensed 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 DVLA, except: ✘- Must not drive if diagnosed with malignant hypertension until condition has been effectively treated or controlled but need not notify DVLA. (Malignant hypertension: elevation in systolic blood pressure greater than or equal to 180 mmHg or diastolic blood pressure greater than or equal to 110 mmHg associated with evidence of progressive organ damage.)	! - May drive and need not notify DVLA, except: ✘- Must not drive and must notify DVLA if resting BP is consistently: ■ 180 mm Hg or higher systolic and/or ■ 100 mm Hg or more diastolic ■ or if diagnosed with malignant hypertension May be relicensed/licensed after BP is controlled, provided there are no side-effects from treatment that affect or are likely to affect safe driving.

Cardiomyopathies

Note: DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction is less than 40%.

Also refer to the following sections in this document:

• arrhythmia
• pacemaker implant
• implantable cardioverter defibrillator
• the European Society of Cardiology HCM Risk of Sudden Cardiac Death Calculator in Appendix C

Hypertrophic cardiomyopathy (HCM)

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Must not drive if in the High Risk groupgroup, (asas per ESCEuropean Society of Cardiology (ESC) HCM Risk-SCDRisk-Sudden calculatorCardiac -Death see(SCD) calculator (see Appendix C)* foror details) and/or if ICD is indicated/implanted.indicated or implanted. Licence will be refused/revoked.refused or revoked. If in the Low Risk or Intermediate Risk group licensing will be permitted if the applicant or driver is able to complete the full 9 minutes of the standard Bruce Protocol exercise tolerance test (or energy equivalent using a cycle ergometer)ergometer). (see See Appendix C for for details). details. Should the applicant or driver be unable to exercise for non-cardiovascular reasonsreasons, cardiac MRI imaging must not reveal more than 15% of ventricular myocardium demonstrating gadolinium enhancement. *The ESC HCM Risk-SCD calculator is not applicable to cases of hypertrophic cardiomyopathy of non-sarcomeric origin (for example, Fabry Disease).
Symptomatic	✓- May drive and need not notify DVLA.DVLA providing that the symptoms do not cause incapacity or detract from safe driving. There must be no other disqualifying condition (must meet all other relevant standards, egfor angina,example angina or arrhythmia).	✘- ✘ – Must not drive and must notify DVLA. LicenceDVLA willfollowing besyncope. refusedLicensing or revoked. Relicensingrelicensing will berequire consideredappropriate oncespecialist symptomsassessment* areto satisfactorilydetermine controlled and the criteriacause for asymptomatic HCM met as detailed above. If there is a history of associated syncope the standardsepisode for syncope need to be met in addition.

Dilated cardiomyopathy

	Group 1 Car and motorcycle	Grouprisk 2of Busa andfurther lorry
Asymptomaticevent.	✓-✘- MayMust not drive and needmust not notify DVLA. ThereLicence mustwill be norefused otheror disqualifying condition.	! - May drive but must notify DVLA.revoked. LVRelicensing ejectionwill fraction must be atconsidered leastonce 40%symptoms andare theresatisfactorily mustcontrolled be no other disqualifying condition.
Symptomatic	✓- May drive and needthe notcriteria notifyfor DVLA. Thereasymptomatic mustHCM beare nomet otheras disqualifyingdetailed condition.	✘- Must not drive and must notify DVLA.above. LicenceEpisodes mayof besyncope issued/renewedwill oncerequire asymptomatic,appropriate ifspecialist LVassessment* ejectionto fractiondetermine isthe atcause leastof 40%the episode and thererisk isof noa otherfurther disqualifying condition.event.

*The ‘appropriate specialist’ must be a consultant cardiologist.

Arrhythmogenic right ventricular cardiomyopathy and allied disorders

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA.	✘- Must not drive and must notify DVLA. May be relicensed/licensed following specialist electrophysiological assessment, provided there is no other disqualifying condition.
Symptomatic	✘- Must not drive and must notify DVLA if arrhythmia has caused or is likely to cause incapacity. May be relicensed/licensed once arrhythmia is controlled, provided there is no other disqualifying condition.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing 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 1-3 year licence may be considered if the specialist electrophysiological review is satisfactory. For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Heart failure (including ischaemic cardiomyopathy and dilated cardiomyopathy)

Refer to NYHA classification detailed below.

	Group 1 car and motorcycle	Group 2 bus and lorry
Asymptomatic NYHA Class 1	✓- May drive and need not notify DVLA.	! - May drive if LV ejection fraction is at least 40% but must notify DVLA.
Symptomatic
- NYHA class II	! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify DVLA.	! - May drive if left ventricular ejection fraction is at least 40%, symptoms are stable and not likely to distract the driver or otherwise affect safe driving but must notify DVLA.
- NYHA class III	! - May drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving but need not notify DVLA.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%.
- NYHA class IV	✘- Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1, II or III.	✘ - Must not drive and must notify DVLA. Licence will be refused or revoked. Relicensing can only be considered if symptoms controlled and in NYHA 1 or II, and left ventricular ejection fraction is at least 40%. Depending on the likely cause for heart failure, exercise or other functional testing may be required irrespective of the NYHA class (see Appendix C).
Left ventricular assist device implanted	✘- Must not drive and must notify DVLA. Driving may be relicensed under individual assessment only after 3 months from implantation.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked permanently.

New York Heart Association (NYHA) classification of heart failure

The New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):

• class I no limitation of physical activity – ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)
  
  
• class II slight limitation of physical activity – patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)
  
  
• class III marked limitation of physical activity – although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically ‘moderate’ heart failure)
  
  
• class IV inability to carry out any physical activity without discomfort – symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically ‘severe’ heart failure)

Cardiac resynchronisation therapy (CRT)

	Group 1 car and motorcycle	Group 2 bus and lorry
CRT pacemaker	✘- Must not drive for 1 week and must notify DVLA. Driving may resume after at least 1 week following implantation if: ■ there are no symptoms likely to affect safe driving ■ there is no other disqualifying condition	✘- Must not drive and must notify DVLA. Driving may resume after at least 6 weeks following implantation if: ■ LV ejection fraction is at least 40% ■ the requirements under heart failure section (see above) are met ■ there is no other disqualifying condition
CRT defibrillator	! - May drive subject to following provisions being met but must notify DVLA. Provisions: ■ the requirements under implantable cardioverter defibrillator (ICD) are met ■ there is no other disqualifying condition	✘- Must not drive and must notify 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
	✘- Must not drive for at least 6 weeks after surgery. Need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive for at least 3 months following surgery and must notify DVLA. May be relicensed after 3 months provided: ■ remains asymptomatic ■ the requirements for exercise or other functional tests can be met (see Appendix C) - annual testing is required ■ LV ejection fraction at least 40% ■ there is no other disqualifying condition

Pulmonary arterial hypertension (including chronic thromboembolic pulmonary hypertension) – an established diagnosis (under the care of a specialist centre)

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - Must notify DVLA. Low, intermediate risk category May drive provided no other disqualifying condition. Review 3 year licence to be issued. High risk category May drive provided satisfactory specialist assessment and the risk of a sudden and disabling event is deemed to be less than 20% per annum; there should be no other disqualifying condition and syncope standards need to be met. Review 1 year licence to be issued. Classification of low, intermediate or high risk categories as per 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Specialist assessment report will be needed for the above risk assessment.	✘- Must not drive and must notify DVLA. Low risk category Driving may be allowed provided satisfactory specialist assessment and the risk of a sudden and disabling event is deemed to be less than 2% per annum; there should be no other disqualifying condition and syncope standards need to be met. Review 1 year licence will be issued. Intermediate, high risk category Licence will be refused or revoked. Classification of low, intermediate or high risk categories as per 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Specialist assessment report will be needed for the above risk assessment.

Heart valve disease

Note:

• also refer to heart valve surgery
• separate standards for aortic stenosis, see below.

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Asymptomatic	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.
Symptomatic (please refer to heart failure standards if relevant)	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. Relicensing considered once asymptomatic and no other disqualifying condition. If there is cerebral embolism, relicensing may be considered after 12 months following cardiological assessment.

Aortic stenosis (to include sub-aortic and supra-aortic stenosis)

See Appendix C for the definition of ‘severe’ asymptomatic aortic stenosis.

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
AsymptomaticWithout symptoms of syncope or presyncope, or without symptoms that a clinician considers likely to impact on safe driving	✓- May drive and need not notify DVLA.	! - If mild toor moderate aortic stenosis, may drive and need not notify DVLA. Moderate aortic stenosis must be under regular medical review and DVLA must be notified if this progresses to severe aortic stenosis. ✘- If severe aortic stenosis, must not drive and must notify DVLA. An annual review licence may be issued, provided: ■ DVLA exercise tolerance test requirements are met (see Appendix C) ■ there is satisfactory medical follow-up Licensing will be refused if: ■ during an exercise testtest, symptoms develop, blood pressure falls or there is sustained arrhythmia ■ a cardiologist considers that exercise testing would be unsafe for the individual ■ aShould testthe isapplicant notbe possibleunable to exercise for anynon-cardiovascular otherreasons reasona specialist’s report should address the risk of an incapacitating event (must be no more than 2% per year).
SymptomaticWith symptoms of syncope or presyncope, or with symptoms that a clinician considers likely to impact on safe driving	✘- Must not drive and must notify DVLA. Licence will be refused or revoked pending assessment and treatment.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked pending assessment and treatment.

Heart valve surgery – including transcatheterpercutaneous aortic valve implantation and other cardiac or pulmonary percutaneous devicesintervention

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
	✘- Must not drive forfor: ■ 4 weeks butin needcase of surgical intervention ■ 2 weeks in case of percutaneous valve intervention Need not notify DVLA. Driving may resume only after 4the weeks,above periods, provided there is no other disqualifying condition.	✘- Must not drive for 3 months and must notify DVLA. May be relicensed/licensedrelicensed or licensed only after 3 months, provided:provided there’s: ■ 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 DVLA if asymptomatic and does not fall under any other category which requires notification to DVLA.	! - May drive, but must notify DVLA. Licence will be refused or revoked if CHD is severe. * Otherwise, DVLA may issue a licence for medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is: ■ mild/moderate disease * ■ successful cardiac or pulmonary intervention (percutaneous device or surgery) ■ no other disqualifying condition
Symptomatic	✘- Must not drive and must notify DVLA. Symptoms include angina, palpitations, dyspnoea, symptoms related to uncontrolled hypertension, heart failure, 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 they fall under any other category which requires notification to DVLA, must notify DVLA. Individual assessment of symptomatic cases. 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.	✘- Must not drive and must notify DVLA. Licence will be refused or revoked if CHD is severe. * Otherwise, following individual assessment of cases, DVLA may issue a licence subject to medical review at 1, 2 or 3 years, depending on specialist assessment and provided there is: ■ mild/moderate disease * ■ successful cardiac or pulmonary intervention (percutaneous device or surgery) ■ no other disqualifying condition

*See classification of congenital heart disease complexity and the section in Appendix C.

For syncope, refer to ChapterAppendix 1D..

• Transient loss of consciousness

ECG abnormality – suspected myocardial infarction

	Group 1 car and motorcycle	Group 2 bus and lorry
	✓- May drive and need not notify DVLA. There must be no other disqualifying condition.	✘- Must not drive and must notify DVLA. May be relicensed/licensed, provided: ■ exercise or other functional test requirements from 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 DVLA. There must be no other disqualifying condition.	! - May drive but must notify DVLA. May be relicensed/licensed if: ■ myocardial perfusion scan or stress echocardiography requirements from 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 DVLA. There must be no other disqualifying condition.	! - May drive and need not notify DVLA, except: If associated with arrhythmia must meet the relevant requirements (see arrhythmias) There must be no other disqualifying condition.

Long QT syndrome - all cases of Long QT syndrome must notify DVLA

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘ - Must not drive if history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA. Licence will be refused/revoked. Relicensing will be considered upon appropriate specialist cardiologist assessment and standards of syncope met.	✘ - Must not drive if symptomatic or history of syncope or Torsades de pointes or QTc* greater than 500ms and must notify DVLA. Licence will be refused/revoked. Relicensing may be considered once asymptomatic and upon appropriate specialist cardiologist assessment and standards of syncope met.

* corrected QT interval

Brugada syndrome -found allby casesan ofECG (Type 1 pattern)

Brugada syndromeECG must(spontaneous notifyor DVLA

drug induced) without any associated symptoms

	Group 1 carCar and motorcycle	Group 2 busBus and lorry
	✘-✓- MustMay drive and need not drivenotify ifDVLA.	✘- historyLicence ofwill syncopebe possiblyrevoked. Relicensing is dependent upon favourable report from an appropriate specialist.*

Brugada ECG (spontaneous or drug induced) with associated transient loss of consciousness (T-LOC) or arrhythmia

	Group 1 Car and motorcycle	Group 2 Bus and lorry
Symptoms clinically confirmed to Brugadabe syndromereflex syncope only	✓- May drive and need not notify DVLA provided the relevant T-LOC standards are met.	✘- Licence will be revoked. Relicensing is dependent upon favourable report from an appropriate specialist.*
Arrhythmia associated with incapacity or history of sudden aborted cardiac death	✘- Must not drive and must notify DVLA. LicenceRelicensing will be refused/revoked.considered upon appropriate specialist assessment* and provided the relevant T-LOC, ICD, and arrhythmia standards are met.	✘- Must not drive and must notify DVLA. RelicensingLicence will be consideredpermanently uponrevoked.
Loss appropriateof specialistconsciousness cardiologistwith assessment.no cause identified	✘✘- - Must not drive ifand symptomaticmust ornotify historyDVLA. Relicensing ofwill syncopebe possiblyconsidered associatedupon toappropriate Brugadaspecialist syndromeassessment* orand historyprovided the relevant loss of suddenconsciousness, abortedICD, cardiacand deatharrhythmia standards are met.	✘- Must not drive and must notify DVLA. LicenceRelicensing will be refused/revokedconsidered permanentlyupon ifappropriate historyspecialist assessment* and provided the relevant loss of syncopeconsciousness, possiblyICD, associatedand toarrhythmia Brugadastandards syndromeare met.

*An appropriate specialist is either a consultant electrophysiologist or historya ofspecialist suddenin abortedinherited cardiac death.

Otherwise,conditions.

The relicensingreport mayshould address the risk of a further event (must be consideredno oncemore asymptomaticthan 20% per annum for Group 1 licensing and uponno appropriatemore specialistthan cardiologist2% assessmentper annum for Group 2 licensing).

Carotid artery stenosis

	Group 1 Car and standardsmotorcycle	Group 2 Bus and lorry
	✓- May drive and need not notify DVLA.	! - Should not drive unless, in the view of syncopean met.appropriate healthcare professional, it is safe to do so. Must notify DVLA. If the level of stenosis is over 50% the requirements for exercise or other functional tests must be met – see Appendix C.