Protocol for Initial Evaluation of Implanted Pacemaker
A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the 2-month recovery period, submit the following:
- ☐ Hospital records. Copies of hospital admission summary medical records pertaining to pacemaker. This includes history and physical, operative report, discharge summary, coronary catheterization or ischemia work up (if performed), and all ECG tracings. Pacemaker information must include the make of the generator and leads, model, and serial number.
- ☐ Cardiology narrative. A typed narrative or clinical note from your cardiologist detailing your interim and current cardiac condition, functional capacity, medical history, and medications. It must also include:
- ☐ Evaluation of pacemaker function, programmed pacemaker parameters, exclusion of myopotential inhibition and pacemaker induced hypotension (pacemaker syndrome), elective replacement indicator/end of life (ERI/EOL), and battery voltage.
- ☐ Pacemaker Status Summary* (PDF)
- ☐ Evaluation of Pacemaker Dependency. For 1st and 2nd class (including limited 2nd class). A test for pacemaker dependency should be performed as follows:
- Sitting or standing. Not supine.
- Turn the pacemaker off or adjust the capture to a rate of 30 beats per minute or less.
- Pace for 3 minutes and record on strip.
- Include a narrative of the symptoms (or lack of) during the 3-minute period.
- ☐ Lab. Current fasting blood sugar and a current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides.
- ☐ Cardiac monitor. A current Holter monitor or similar evaluation for at least 24-consecutive hours to include select representative tracings. It must list:
- Atrial and ventricular ectopic counts/burden;
- Hourly tabular data to include the longest pause duration and counts of all pauses >2.0 or 2.5 seconds;
- Heart rate (max and min), other day-by-day histograms, and frequency graphs; and
- Percentage of time in atrial fibrillation/flutter
- ☐ Echo. A current M-mode, 2-dimensional echocardiogram with Doppler.
- ☐ Stress test. A current Maximal Graded Exercise Stress Test Requirements (GXT). If a radionuclide stress (RS) or cardiac angiogram (cardiac catheterization) were performed, submit those images and reports. Due to poor image quality, Xeroxed or faxed images will not be accepted.
It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification.
To aid in the review process, it is critical that the airman's full name and date of birth appear all correspondence and reports. Send all information in
|Using regular mail (US Postal Service)||Using special mail (FedEx, UPS, etc.|
|Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-313
PO Box 25082
Oklahoma City, OK 73125-9914
|Federal Aviation Administration
Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
6700 S MacArthur Blvd., Room B-13
Oklahoma City, OK 73169
No consideration can be given for special issuance until ALL the required data has been received.
*Note: The Pacemaker Status Summary (PDF) is not required, however, it will help to streamline and significantly DECREASE FAA review time.