A 55-year-old airman who held a third-class medical certificate experienced a heart attack one year prior, and developed a heart arrhythmia known a ventricular tachycardia. This is a very serious situation as it many times degenerates into what is known as the “dying heart rhythm,” or ventricular fibrillation. Fortunately, this occurred while he was running to catch a commercial flight and there was a nurse and physician nearby who used an automated external defibrillator (AED).
This is a device that has two “leads” that have jelly impregnated on them and are placed on the chest. The device analyzes the heart rhythm and if it is one of the rhythms mentioned above will “shock” the heart, hopefully back into a “normal” rhythm, and thus save the individual. The AED performed as advertised and restored a regular rhythm in the gentleman. The paramedics arrived and took the pilot to a local hospital. While he was there the doctors placed three stents into his blocked coronary arteries. They also inserted what is known as an internal cardiac defibrillator, or ICD device. This is a version of the same device noted above but the leads are attached directly to the heart and the battery generator is placed under the skin. Yes, this device is usually permanent.
The airman waited the appropriate time of six months (now three months) and presented his case to the FAA's Medical Appeals Section. He was denied a special issuance secondary to having the ICD device. The FAA does not permit such a device if it is “active.” The ICD device is inserted by cardiologists who feel that their patients have a condition that makes them “prone” to developing a heart rhythm that could lead to sudden death. So, if one were flying and developed one of these serious irregularities (or arrhythmias) the device would analyze and send out a discharge, hopefully shocking the heart back into a “normal” rhythm. The FAA’s position with this device is similar to that of flying while using an unacceptable medication. It is not so much the medication (or medical device) that is an issue with certification, but the actual medical condition. In this airman’s case, does his heart condition make him prone to developing one of these severe irregularities? He would have to demonstrate that he did not have such a situation and in the case of the ICD would also have had to show that the device had not “fired” for at least the previous two years. That said, he would also have to convince his treating cardiologist either to deactivate the device or to remove it (explant) completely in order to be considered for special issuance.
Anyone who is being considered for a permanent pacemaker implantation, should be aware of the option to have the unit implanted with the or whose physician is contemplating having one inserted also need to know that these days one can have a pacemaker that also has the capability to be an ICD. The ICD portion can be “turned off.” This would have to occur to be considered for a special issuance.
So, this fellow will have several issues to discuss with his cardiologist, but the medical certification folks at AOPA's Pilot Protection Services gave him all the necessary information to make a decision.
Once again, my advice is to listen to your treating physicians and take care of yourselves first and don't let your medical certificate dictate your health decisions. Call the Pilot Protection Services folks and find out your options.
