Wildflyin

Hi all,

I recently found out I have afib. I am young and healthy otherwise, and was already working as an airline pilot a while back. I had left the career (non medical reasons) and wanted to return when this happened. I went through a gambit of tests that show it is just a small electrical issue, nothing structurally wrong at all. The Dr said it can be controlled via anti-arrythmic medication. What is my next step here? I currently hold a class 1 that expires in the spring, but i have stayed out of the cockpit since this happened since i want to make sure it is controlled. Any ideas? Thank you!

CaptYoda

First off, I assume this was not reported previously on your class I medical as you left the industry and did not exercise privileges with this condition even though your medical is still valid. So first step would be to report the condition on your next physical and provide all the documentation to the AME who will likely defer the medical to the FAA for review and issuance of a special issuance or regular medical. It is very important to submit everything the FAA requires and exactly as per their protocol, otherwise they will reject your application and it will delay re-certification. Special issuance medicals can take 2-3 months so it is best to probably do all this before you current medical expires. You can use companies who help with this process (leftseat.com, AMAS etc) and they charge $1000 or more for this service. Also AOPA can help if you are a member and use their service. Below is some info from AOPA that may be helpful. Pay special attention to the required documentation section. Best of luck.


Atrial fibrillation occurs when instead of one area in your atrium (the upper chambers in the heart) controlling the electrical beating of the heart, there are many areas where the electrical impulse originates, most times up to 250 atrial beats. Not all of these beats make it through to the ventricles and thus cause the heart to beat. This is because the area that they pass through, called the atrial-ventricular (AV) node, has a resting phase so that electrical impulses that reach it will not allow the impulse to fire the ventricles. When a person first gets atrial fibrillation, many of these impulses are getting through so the heart is usually beating quite fast. The name of the game is to prevent the abnormal rhythm or to increase the resting phase through the AV node.

Several things can cause atrial fibrillation: a heart attack; a thyroid condition; conditions that cause enlargement of the atria chambers, such as heart valve problems; and excessive alcohol consumption, to name some of the common ones. The FAA wants the airman to show that his or her treating physician has ruled in/out these conditions, so when initially presenting one’s case, they agency wants you to have this documentation:

A maximal exercise stress test, to rule out coronary disease;
An echocardiogram of the heart to see whether there are valve problems or enlargement of the heart chambers;
A good evaluation by your treating internist or cardiologist that should explain how you presented, what was done to treat the condition, and what will be the treatment; and
A set of thyroid function studies.
The FAA will want the atrial fibrillation to be controlled, meaning either to slow the electrical impulses bombarding the ventricles or to get you out of the abnormal rhythm altogether. This can be accomplished by electrically shocking the heart into a regular rhythm, called cardioversion; actually eradicating the areas in the atria that are causing these beats to occur, called radiofrequency ablation; or by giving you drugs that will cause the rhythm to go away. If your physician decides to use the cardioversion or ablation procedures, the FAA has a policy to keep you grounded for 30 days*. However, a radiofrequency ablation needs 90 days of stability. Both treatments will require the same treatment and procedure records, a 24 hour Holter monitor and ECG, and a status report from the treating physician.

The phenomenon of atrial fibrillation causes blood to stagnate in the atria and ultimately form clot. This clot can break loose and cause you to have a stroke. For many years the main treatment to prevent clot formation has been what lay people call blood thinners. Actually, this medication called warfarin causes your blood to take a longer time to clot. There are several newer medications on the market. Several of the common ones are Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban). These medications affect the cycle of coagulation in your blood. All of these medications are acceptable to the FAA for treatment with some stipulations.

The FAA does accept the majority of medications that are used to prevent one from re-developing atrial fibrillation.

Capt Yoda-My own added note: Maximal Stress Test (Bruce Protocol) is at 100% of your predicted heart rate and not what most cardiologists are used to giving (normally only 80-85% of your predicted heart rate) You must have it done as per FAA and their website has guidance on all the specific types of protocols.

You will get sticker shock because for the initial certification many tests, costing thousands of dollars are required and insurance may not pay for it. For example after heart bypass, they require an angiogram after 6 months of surgery which can cost $$$$$ and since it is not a test normally required, insurance will not pay for it. FAA also wants current tests and they define this as within 90 days. After initial certification you will have to provide yearly reports as well to keep your medical valid but they may not be as expensive but I think one should plan for around $1000 each year for a special issuance protocol medical as a minimum just for all the tests and status reports required and in case insurance does not pick up the tab.

Wildflyin

Thanks, i did go through all those tests in September and they all came back clear to include a sleep study. I don't know if yhey considered the stress test a 100% one, I will find out at my appointment today. Thanks for the help

CaptYoda

I would suggest scheduling your FAA medical as soon as you can because the FAA will not review any cases unless you have an active medical file (i.e a medical application). Since you did the tests in September you run the risk of having the tests being considered not up to date (90 days validity) for your medical. It would be a shame to have to redo all of them. If you do a medical now and submit all the required tests(which are less than 90 days old) on that date you may avoid this predicament. Also, make sure you have exactly what the FAA lists as required reports (word for word). Good luck! I did a special issuance a while back without using any service and it was relatively hassle free so long as you give them what they want.

CaptYoda

Here is the FAA protocol for Afib renewals. Notice that some tests which are required for initial certification (e.g. stress test) are not required for reissuance.
For initial it seems that he would have to defer to OKC with all reports which were posted earlier. Please check with your AME for latest FAA information. My information may not be fully updated and I am not a medical professional.

AASI FOR 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
issuance of an Authorization for the above disease/condition, and the applicant
has all of 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
the last 90 days; and
• A minimum of monthly International Normalized Ratio (INR)
results for the immediate prior 6 months.
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, or any other
cardiac condition previously not diagnosed or reported.
LAST UPDATE: April 3, 2006

CaptYoda

https://www.aopa.org/go-fly/medical-...ol-stress-test

Wildflyin

Resurrecting this thread to say HAPPILY, that it turned out I did not actually have AFIB. I went for a second opinion to a much more renown cardiac care location and it turned out what I actually had was a particularly nasty SVT which was managing to rope in in other electrical nodes in my heart when it went haywire. The good news here is that it was much more treatable, and I just had a successful ablation surgery this past Friday. Now, my focus is to get back in the air. I am assuming that the required observation period and tests are approximately the same as was posted before?

Wildflyin

I answered my own question. Here is what I found on AOPA:

https://www.aopa.org/go-fly/medical-...tem/arrhythmia

Radio Frequency Ablation

Many types of arrhythmias can be successfully treated with catheterization procedures. Radio frequency ablation uses high-frequency energy delivered through an electrode catheter to the area of origin of the abnormal rhythm. The energy that's delivered to the site interrupts the source of the arrhythmia.

For recertification after having RF ablation the FAA requires:

90 days of stabilized recovery.
After the recovery period, a current 24-hour Holter monitor
Resting electrocardiogram (ECG);
Medical records and a detailed status report from the treating physician.
*If this is a first time report of a cardiac condition, a maximal exercise stress test will also be needed.

CaptYoda

Congratulations in advance on your pending return!

Wildflyin

So, I only just submitted paperwork to get my Class 1 back. Looking to get back in the cockpit for a career after the hiatus. Anyone know how long it takes after submitting all the medical records after an ablation to get an approval for a Class 1?