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 report of a minimum 24-hour cardiac monitor performed within last 90 days. (Cardiac monitor report must be submitted, even if findings are normal, and should include 1-page computerized summary and the representative full-scale multi-lead ECG tracings);
  • A completed FAA Atrial Fibrillation (AFib)/A-Flutter Recertification Status Report (PDF) OR a cardiologist evaluation that addresses all items on the recertification status report; and
  • The above data verifies
    • No interval evidence or suspicion of stroke, TIA, or other thromboembolic event.
    • Heart rate is well controlled on cardiac monitor by cardiologist interpretation.
    • If symptom, rate, or rhythm control is indicated and, if so, a description of how it this is managed.
    • When CHA2DS2-VASc score ≥ 2, verify emboli mitigation is in place without side effects. See Pharmaceuticals - Anticoagulants - Emboli Mitigation (PDF).


The Examiner must defer to the AMCD or Region if:

  • Applicant had left atrial appendage (LAA) occlusion (Watchman)/excision or developed a new cardiac condition;
  • There has been an interval definitive or suspicious thromboembolic event;
  • Cardiology interpretation indicates questionable or poor rate control. Average heart rate is > 100, maximum (non-exercise) is > 120, or a single pause is > 3 seconds;
  • Evidence that symptoms, rate, or rhythms are not well controlled;
  • CHA2DS2-VASc (PDF) is ≥ 2 and emboli not mitigated; (Acceptable emboli mitigation under AASI authorization is anti-coagulation with either NOAC/DOAC/warfarin. When using warfarin/Coumadin, if more than 20% of INR values are less than 2.0 or greater than 3.); and/or
  • Interval bleeding that required medical intervention.


Last updated: Thursday, March 9, 2023