3.4 ATRIAL FIBRILLATION (AFIB)
Rev SEP 95
AEROMEDICAL CONCERNS: See atrial flutter (3.5 below).
WAIVER: The condition is CD. No waivers are recommended in recurrent cases or in candidates, but a return to full flight status is possible 6 months following a single episode of atrial fibrillation with a documented precipitating factor (e.g. Holiday Heart). No medications are waiverable. Waivers are not recommended for candidates.
INFORMATION REQUIRED: Complete cardiology consultation is required, to include exercise treadmill testing, echocardiography and three Holter monitor studies at monthly intervals. Exclusion of secondary causes is mandatory, including an exact detailed history of the event(s)(i.e. alcohol use, thyroid, stimulant use, sleep, stress, etc).
DISCUSSION: The condition is a result of chaotic atrial activity (P waves not discernible) at a rate generally between 350-600, with an irregularly irregular ventricular response (rate 120-160) except in patients on digoxin, beta blockers, high vagal tone, or intrinsic AV nodal disease. Causes are many: rheumatic heart disease (RHD), atrial septal defects (ASD), pulmonary emboli (PE), coronary artery disease (CAD), cardiomyopathies, postoperative heart surgery, hypertension, and pericarditis. A single episode of AFIB may occur without underlying heart disease, and can be associated with high caffeine intake, smoking, and excessive ETOH intake. In 50% of cases of atrial fibrillation, the cause is underlying disease such as left ventricular failure, mitral valve disease, pericardial disease, chronic obstructive lung disease, sinus node disease or hyperthyroidism. There is a 17-fold increase in stroke in patients with atrial fibrillation caused by mitral valve disease compared to a 5-fold increase in risk in patients where the fibrillation arises from all other causes. Cardioversion is 90%successful in restoring rhythm in flutter but there is a relatively high relapse rate (50%) in fibrillation. Patients with idiopathic, paroxysmal atrial fibrillation have no increased mortality compared to normals.
427.31 Atrial Fibrillation
3.5 ATRIAL FLUTTER (AF)
Rev APR 94
AEROMEDICAL CONCERNS: Acute atrial flutter may result in a runaway ventricular response rate. AF may be associated with chest pain, syncope or near syncope. There is a significantly increased incidence of embolic phenomena.
WAIVER: The condition is CD. Waivers are not recommended for recurrent atrial flutter or atrial fib/flutter in the absence of precipitating factors. A return to full flight status has been recommended for some cases of isolated atrial flutter with documented precipitating factors. Waivers are not recommended for candidates.
INFORMATION REQUIRED: Complete cardiology consultation is required, to include exercise testing, echocardiography and three Holter monitors at monthly intervals. Individuals are grounded for six months pending evaluation. No medications are waiverable. Other secondary causes for atrial flutter must also be excluded (alcohol intoxication, hyperthyroidism).
DISCUSSION: An atrial rate (P wave) of 250-350 and varying degrees of AV block is the most common presentation, with 2:1 block the most common. Characteristic "saw-tooth" waves (flutter waves) may be seen in the inferior leads.
427.32 Atrial Flutter
