Skip to page content

Guide for Aviation Medical Examiners

Special Issuances
AME Assisted - All Classes - Atrial Fibrillation

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.

If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

  • An Authorization granted by the FAA;
  • 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
  • If using Coumadin (Warfarin), obtain a minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months (see below*).
  • If using other types of anticoagulants such as NOAC/DOAC (i.e., Xarelto, Eliquis, Pradaxa, Savaysa, etc.), the airman should obtain a statement from their treating/prescribing physician with details of the underlying condition, tolerance of the medication to include the presence or absence of side effects, any bleeding episodes requiring medical attention, and any occurrence/recurrence of deep vein thrombosis or pulmonary embolism.

The Examiner 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 that required medical intervention, or any other cardiac condition previously not diagnosed or reported.

Page last modified:

This page was originally published at: