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Guide for Aviation Medical Examiners

Decision Considerations - Aerospace Medical Dispositions
Item 36. Heart - Atrial Fibrillation

Atrial Fibrillation (AFib)/A-Flutter - All Classes

Disease/Condition Evaluation Data Disposition
A. Non-Valvular AFib/A-Flutter

History of at any time OR current:

Single or multiple episodes

Paroxysmal
Persistent
Permanent/chronic

History of ablation or cardioversion

Untreated or treated

Submit the following to the FAA review:

Non-Valvular Atrial Fibrillation (AFib)/A-Flutter INITIAL Status Report (PDF) OR

☐ A current clinical summary from the treating cardiologist describing all items on the AFib/A-Flutter Status Report sheet.

☐ Initial etiology work-up as follows:

  • TSH;
  • Sleep Study;
  • ≥ 24 hour cardiac monitor;
  • Cardiac echocardiogram; and
  • Exercise stress test

☐ If taking Warfarin, submit info listed on Pharmaceutical Anticoagulants - Emboli Mitigation (PDF).

DEFER

Submit the information to the FAA for a possible Special Issuance.

Follow-up Special Issuance -
Will be per the Airman's authorization letter

See Non-Valvular Atrial Fibrillation (AFib)/A-Flutter RECERTIFICATION Status Report (PDF)

B. Treated with left atrial appendage (LAA) closure device

ex: Watchman

After a 6-month recovery period, submit the following to the FAA for review:

☐ Cardiologist evaluation that describes why the procedure/device was indicated, treatment regimen throughout the process, any procedure complications, whether device is working properly, and the current status of AFib;

☐ Current CHA2DS2-VASc score (PDF);

☐ Initial AFib etiology work up (TSH, sleep study, ≥ 24 hour cardiac monitor, cardiac echocardiogram, exercise stress test), if not previously submitted;

☐ Procedure report;

☐ TEE report from time of implantation, if performed (images not required in most cases); and

☐ TEE report from ≥ 45 days post procedure to evaluate for peri-device leaks (Recommended images at 0, 45, 90, and 135 degrees with 2-4 heartbeats to show appendage and occlusion device or in accordance with industry standards).

DEFER

Submit the information to the FAA for a possible Special Issuance.

Follow-up Special Issuance -
Will be per the Airman's authorization letter

C. Valvular AFib Submit the following to the FAA review:

☐ Cardiac echocardiogram;

☐ ≥ 24 hour cardiac monitor

☐ Cardiologist evaluation describing:

  • AFib and valvular problem history, to include valvular intervention, if performed;
  • Whether AFib symptom, rate, or rhythm control is required and, if so, details of such; and
  • Current CHA2DS2-VASc (PDF) score, emboli mitigation requirement, and emboli mitigation strategy, if applicable.

DEFER

Submit the information to the FAA for a possible Special Issuance.

Follow up Issuance Will be per the airman's authorization letter

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