Atrial fibrillation fact sheet

Atrial fibrillation (AF) is a type of heart irregularity (arrhythmia). The heart beats both fast and abnormally and 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. An artificial pacemaker may be inserted to maintain regular heart rhythm.

Overall, AF affects around 2 in every 100 people. However, the risk increases with age, with more than one in 10 people aged 75 years or older affected. Atrial fibrillation is, therefore, one of the most common types of arrhythmia.

Arrhythmias are responsible for between 23,000 and 33,000 sudden cardiac arrest deaths each year, many of which could be avoided with greater public awareness of their risks and symptoms. Atrial fibrillation increases the chance of someone suffering a stroke by 5 times.

Symptoms are not always obvious but may include palpitations or a fluttering heartbeat, irregular heartbeat, chest pains, dizziness and fainting spells. Treatment is important, even if the AF does not present with any symptoms. Untreated, complications can include stroke and heart attack.

The effect of aviation on the condition

An acute episode of AF during flight can cause:

  • hypoxia: insufficient oxygen in the blood, which can be caused by flying non-pressurised aircraft above 3,000 metres without supplemental oxygen; rapid decompression during flight; pressurisation system malfunction; or oxygen system malfunction
  • stress response
  • fatigue.

The effect of the condition on aviation

An AF during flight can cause a number of 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).

The effect of treatment on aviation

  • Taking anticoagulants can increase the risk of excessive bleeding (haemorrhage).
  • Clinical use of beta-blockers may adversely affect performance.

Implications for pilots and controllers

  • Any recurrence of significant symptoms mandates grounding and reporting to the Designated Aviation Medical Examiner (DAME).
  • Any recurrence of symptoms post radio frequency ablation (RFA) mandates grounding and reporting to the DAME. (RFA is a procedure used to put the heart back into normal rhythm.)
  • International normalised ratio (INR) testing must be performed at least once a month and more frequently if required by the treating doctor or CASA. (The INR is a test of blood clotting, primarily used to monitor warfarin therapy).
  • Warfarin INR tests outside the range 1.5 - 4.0 are not acceptable, leading to mandatory grounding until test results are in range and you are cleared by your DAME. Because of the high risk of strokes, proof of use of anticoagulants other than warfarin will be required. In most cases, failure to use anticoagulants present an unacceptably high risk of stroke.

Approach to medical certification

More likely to be certified

You are more likely to be certified or re-certified if you can show:

  • either satisfactory rate control or rhythm control
  • that surgery has helped eliminate the risk of a further event
  • that aspirin or warfarin have successfully mitigated your risk of thrombosis.

Less likely to be certified

You are less likely to be certified or re-certified if you have:

  • significant symptoms (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 you are affected by an AF will depend on a range of circumstances. CASA makes aeromedical decisions on a case by case basis. A particular assessment decision is based on the individual circumstances of the applicant under consideration.

Further information

For further information see:

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