Atrial fibrillation (AF) is a type of heart irregularity (arrhythmia). AF causes the heart to beat both fast and abnormally. This can cause:
- palpitations or a fluttering heartbeat
- irregular heartbeat
- chest pains
- dizziness or fainting spells.
AF can remain undetected for long periods of time. Complications of untreated AF can include stroke and heart attack.
Treatment options include medication, surgery and electric shock therapy. Medical professionals can insert an artificial pacemaker to maintain regular heart rhythm.
AF affects around 2 in 100 people. However, the risk increases with age with more than one in 10 people aged 75 years or older affected. Atrial fibrillation is one of the most common types of arrhythmia.
Arrhythmias are responsible for between 23,000 and 33,000 sudden cardiac arrest deaths each year. Greater public awareness of their risks and symptoms of arrhythmias can help many avoid adverse health effects. Atrial fibrillation increases the chance of someone suffering a stroke by 5 times.
Treatment is important even if the AF does not present with any symptoms. Untreated, complications can include stroke and heart attack.
Effects of flying on atrial fibrillation
An acute episode of AF during flight can cause:
- hypoxia: insufficient oxygen in the blood. Several factors can cause hypoxia including:
- flying non-pressurised aircraft above 3,000 metres without supplemental oxygen
- rapid decompression during flight
- pressurisation system malfunction
- oxygen system malfunction.
- stress response
- fatigue.
Effects of atrial fibrillation on operators
An AF during flight can cause several undesirable symptoms, including:
- overt incapacitation:
- big increase in risk of stroke
- collapse of the cardiovascular system, signalled by a significant drop in blood pressure, leading to multi-organ failure and death
- loss of Gz-tolerance
- blood vessel obstruction by a blood clot that has become dislodged from another site in the circulation.
- subtle incapacitation
- distraction due to:
- symptoms
- dyspnoea (difficult or laboured breathing).
Effects of treatment on operators
Taking anticoagulants can increase the risk of excessive bleeding (haemorrhage). Clinical use of beta-blockers may adversely affect performance.
Implications for pilots and controllers
Symptoms
If you are still having significant symptoms, must ground themself and report to the Designated Aviation Medical Examiner (DAME).
If you keep experiencing symptoms after a radio frequency ablation (RFA), you must ground themselves and must report to the DAME. RFA is a procedure used to put the heart back into normal rhythm.
International normalised ratio test
You must complete an international normalised ratio (INR) test at least once a month and more frequently if required by the treating doctor or by us. The INR is a test of blood clotting, primarily used to monitor warfarin therapy.
If your warfarin INR tests sits outside the range 1.5 to 4.0 it cannot be accepted. This will lead to mandatory grounding until test results are in range and you're cleared by your DAME. Because of the high risk of strokes, you need proof of use of anticoagulants other than warfarin. In most cases, failure to use anticoagulants present an unacceptably high risk of stroke.
Approach to medical certification
More likely to gain certification
You are more likely to gain certification if you have:
- either satisfactory rate control or rhythm control
- surgery has helped eliminate the risk of a further event
- aspirin or warfarin have successfully mitigated your risk of thrombosis.
Less likely to gain certification
You are less likely to gain certification if you have:
- significant symptoms, including:
- chest pain
- syncope
- pre-syncope
- dyspnoea.
- underlying pathology, including:
- reversible cardiac ischaemia
- valve disease
- significant cardiac dysfunction
- problematic use of alcohol
- thyroid disease.
- inadequate rate or rhythm control
- unstable or inadequate treatment against thromboembolism.
You are unique
Every case of AF is different. How AF affects you will depend on a range of circumstances. We make aeromedical decisions on a case-by-case basis. We base a particular assessment decision on the individual circumstances of the applicant under consideration.
Further information
For further information see the Better Health Channel.