If the Bundle Branch Block (BBB) has been previously documented and evaluated, no further evaluation is required.
A medical certificate should not be issued to any class if the applicant has a new onset of a BBB.
A right BBB in an otherwise healthy person 30 years of age or younger should not require a CVE.
All other individuals who do have a right BBB require a CVE but a radionuclide study should not be required unless
the standard exercise stress test cannot be interpreted. A stress echocardiogram may be sufficient in most cases.
A left BBB in a person of any age should have a CVE and should include a radionuclide perfusion study.
Those individuals who have a negative work-up may be issued the appropriate class of medical certificate.
No followup is required. If any future changes occur, a new current CVE will be required.
Disease Protocols - Graded Exercise Stress Test - Bundle Branch Block Requirements
If areas of ischemia are noted, a coronary angiogram may be indicated for definitive diagnosis. According to the current literature, approximately 40% of individuals with LBBB will demonstrate a false positive thallium reperfusion defect in the septal area. If significant CAD is diagnosed, refer to Special Issuance guidelines. Some cases may be forwarded to a FAA-selected cardiology consultant specialist for review and recommendation for medical certification.