Atrial Fibrillation - SI

[My Flight Surgeon]

This is another in the educational series of posts discussing the Special Issuance process. Atrial fibrillation usually affects older pilots but can affect young pilots occasionally. At one time, this condition disqualified pilots from flight duty. Now, through the Special Issuance process, pilots may fly if they follow proscribed medical regimen for the management of atrial fibrillation.



What is atrial fibrillation (AF)?
Atrial fibrillation is a disorder found in about 2.2 million Americans. During atrial fibrillation, the heart's two small upper chambers (the atria) quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.
How is atrial fibrillation treated?
Several approaches are used to treat and prevent abnormal beating:

• Medications are used to slow down rapid heart rate associated with AF. These treatments may include drugs such as digoxin, beta blockers (atenolol, metoprolol, propranolol), amiodarone, disopyramide, calcium antagonists (verapamil, diltiazam), sotalol, flecainide, procainamide, quinidine, propafenone, etc.
• Electrical cardioversion may be used to restore normal heart rhythm with an electric shock, when medication doesn't improve symptoms.
• Drugs (such as ibutilide) can sometimes restore the heart's normal rhythm. These drugs are given under medical supervision, and are delivered through an IV tube into a vein, usually in the patient's arm.
• Radiofrequency ablation may be effective in some patients when medications don't work. In this procedure, thin and flexible tubes are introduced through a blood vessel and directed to the heart muscle. Then a burst of radiofrequency energy is delivered to destroy tissue that triggers abnormal electrical signals or to block abnormal electrical pathways.
• Surgery can be used to disrupt electrical pathways that generate AF.

Coumadin (warfarin or "rat poison") is used to prevent blood clots from forming. This medication needs to be monitored on a regular basis since too much medication can lead to serious bleeding complications.

The FAA standard for the initial evaluation of Atrial Fibrillation is outlined in the link below: http://www.faa.gov/about/office_org/...em36/amd/afib/

Once the FAA grants a Special Issuance, the AME may re-issue the medical certificate if the following conditions are met:

• A summary of the applicant’s medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation;
• The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
• A report of a current 24-hour Holter Monitor performed within last 90 days; and
• A minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months.

The AME must defer to the AMCD or Region if:

• Holter Monitor demonstrates: HR >120 BPM or Pauses >3 seconds;
• More than 20% of INR values are <2.0 or >3.0; or
• The applicant develops emboli, thrombosis, bleeding, or any other cardiac condition previously not diagnosed or reported.