Driving and AF

[5morechristmases]

Afternoon. Having had 3 ablations in the past, I’m now trying to live a normal life. Everything seems to be a ongoing battle now.

I have very few episodes of AF now and if they occur they only last a few hours. I can use flecainide as a pip but not very often.

I’m now trying to regain my lorry, bus and other categories of my licence that were revoked due to my condition. The DVLA have said that my heart ejection fraction rate must be higher than 40%.

I try to live a healthy lifestyle and exercise and swim three times a week. I don’t smoke, lost 3.5 stone in weight and drink 3 pints of beer a week. But It hasn’t made any difference in how I feel as my rate is below 40%.

Anyone out there got advice or tips.

Thanks in advance for any help

[Hidden]

I’ve taken the liberty of making  BenHall1 aware of your post as may have some experience which should be helpful…..

[BenHall1 in reply to Hidden]

G'day FJ.

Noted. 😊

John

[BenHall1]

Hi,

Flapjack said I might be able to cast some light on your post. Well, to start with I don't know how much you know about Ejection Fraction ... nor do I know how old you are ....... so, bear in mind I hold a PCV licence and still drive buses part time these days but I still have to jump through hoops with my annual DVLA inspired medical. As a matter of interest a normal Ejection Fraction is reckoned to be in the vacinity of 52 to 72.

So, forgive me if I am telling you something you already know but lets look at the definition of Ejection Fraction .....

Your doctor may talk about the ‘ejection fraction’ of your heart. This is to do with the amount of blood squeezed out of the main chamber of the heart with every beat. It’s usually measured as a percentage – over 50% is considered normal. Your ejection fraction is measured from an echocardiogram.

Heart Failure can be put into different groups depending on your ejection fraction. Depending on the percentage measured, and other tests, your heart failure may be classed as the following:

i heart failure with preserved ejection fraction (HFpEF) - >50%)

ii heart failure with mildly reduced ejection fraction (>40% - 49%)

iii heart failure with reduced ejection fraction (<40%).

So, that covers the definition. Next I am taking an extract from my last 2 Echocardiograms ... the first taken in October 2020

1 Oct 2020 ....Left Ventricle: Normal LV dimension with mild concentric hypertrophy. Normal systolic function (EF 68%). Grade 1 diastolic dysfunction.

2 November 2022 ….

a) This 78 year old man who is in sinus rhythm has severe concentric left ventricular hypertrophy with a maximal wall thickness of 1.7cm. The left ventricle is not dilated and has normal systolic and diastolic function with an LVEF greater than 60 % .

b) Left Ventricle: Normal LV cavity size by internal dimensions. There is severe concentric LVH with severely increased LV mass when indexed to BSA. Normal LV systolic function. EF estimated >60% using Simpsons bi-plane/2D teich. No obvious RWMA. Normal diastolic function for patient age.

Hope all that helps. As you can see, in just 2 years the state of my heart has in some respects deteriorated. When I had my last (Nov 2022) Echo I asked the guy what he thought ( about my heart) ....... he just said, blandly, well its really done some hard work ! My GP on the other hand when I discussed it with her sdeemed to think it was okay ..... consistent with age !

I suppose if I had your Ejection Fraction I'd be asking my Cardiologist is there any way your EF can be improved .... can it be restored in any way to say, 55% ? or with your current reading of <40% is that it ? If he doesn't know already then explain to him you are trying to meet DVLA's requirement for your professional licence ( and other categories ) to be reinstated. Without second guessing DVLA Medical Services approach I would think they've made this decision in the context of your low EF. I have found in the past when my AF was still troublesome that I could phone Medical Services and have a discussion with them about the line they have taken. Easier said than done I know because of a potentially long telephone wait but it may be worth a try.

I wish I could give you better comments but this is just my take on the issue. By the way, in case you are wondering in my case ... about "severe concentric left ventricular hypertrophy " means

"Concentric left ventricular hypertrophy is an abnormal increase in left ventricular myocardial mass caused by chronically increased workload on the heart, most commonly resulting from pressure overload-induced by arteriolar vasoconstriction as occurs in, chronic hypertension or aortic stenosis".

Best wishes

John

[5morechristmases in reply to BenHall1]

Thanks for the reply. I'm now going through my medical notes to see if it's changed over the last four years.

[Redactrice]

Really helpful comment, very clear and focused -- nothing to do with me, but should help the person for whom it's intended.

[2learn]

Hi, perhaps you need a good heart scan. My ejection fraction rate was 40% because I had a badly leaking heart valve. This has now been repaired and my EFR has gone back upto 59%. The heart scans I had hadn't picked it up so needed a TOE to do so.

[5morechristmases in reply to 2learn]

Thank you. I've now got an appointment with the consultant in November. Hopefully he can answer my questions and offer another heart scan.

[2learn in reply to 5morechristmases]

Hi, forgot to say other thing I had was a stress test and scan before during and after test. This was prior to my heart op as they were concerned that if my EFR was too low they would have to put me into an induced coma after the open heart surgery. Fortunately it was good enough