title: Syncope while driving: pathophysiological features and long-term follow-up.
abstract: BACKGROUND
  Approximately 3% to 10% of patients with syncope experience episodes while driving. The aim of our study was to identify their clinical and pathophysiological features, estimate the incidence of recurrence, and correlate these characteristics with recurrence.
  
  
  METHODS
  We prospectively studied 40 patients who experienced syncope while driving and 50 subjects who experienced syncope in other situations. All cases underwent upright tilt test (UTT), with simultaneous ECG and beat-to-beat blood pressure recordings, to analyze heart rate variability, total peripheral resistance (TPR), and stroke volume (SV).
  
  
  RESULTS
  Patients who experienced syncope while driving suffered more frequently from hypertension (40% vs 20%) and vasodepressive reactions during the UTT (52% vs 26%). Moreover, these patients had increased heart rates (p=0.007) and lower SVs (p=0.006) during a positive UTT. TPR rose immediately before symptoms appeared only in patients who suffered from nondriving syncope (p=0.006). During a mean follow-up of 1793±573 days, 8 syncopic patients while driving had recurrences (20%) but never while driving. They were older, experienced more episodes of syncope, and had a higher incidence of vasodepressive reactions during UTT.
  
  
  CONCLUSIONS
  Our study confirms a good prognosis for patients who experience syncope while driving, and indicates that more accurate risk stratification is needed in subjects aged over 50 years, who have had more than 4 episodes of loss of consciousness and vasodepressive reactions during UTT.
authors: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Italy. franco.folino@unipd.it
authors: Antonio Franco
authors: AF
authors: Folino
authors: Federico
authors: F
authors: Migliore
authors: Alberto
authors: A
authors: Porta
authors: Sergio
authors: S
authors: Cerutti
authors: Sabino
authors: S
authors: Iliceto
authors: Gianfranco
authors: G
authors: Buja
mesh_terms: D000328:Adult; D000368:Aged; D001334:Automobile Driving; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D013995:Time