Several months ago, I wrote about what initial testing is required to gain a special issuance for atrial fibrillation. Now we will discuss how the FAA views the various treatments for this condition.
First, to briefly summarize, atrial fibrillation occurs when instead of one area in the atria (the upper chambers of your heart) controlling the electrical beating of the heart, there are many areas where the electrical impulse originates, often up to 250 atrial beats per minute. Not all of these beats make it through to the ventricles—the lower heart chambers—to create a regular rhythm. 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 atrial fibrillation first develops, many of these impulses are getting through the node, which results in a rapid heart rate. The name of the game is either to prevent the abnormal rhythm or to increase the resting phase through the AV node. Ideally, your physician will first try to get you back into a regular heart rhythm. This is important because sustained untreated atrial fibrillation can result in serious complications.
When an individual is in atrial fibrillation, the “fibrillation” is actually a quivering action of the atrial chambers, and looks something like a bowl of Jell-O being shaken. Because the quivering effect doesn’t result in adequate contraction of the atria to move blood downstream to the left ventricle, the blood can collect and stagnate in the atrium. If even a small volume of blood clots and is released into the ventricle, it can get pushed out of the heart into the aorta, and from there can end up in a number of places it shouldn’t be, including the brain, where it can cause a stroke, an undeniably serious complication. To prevent this, your treating physician will place you on an anticoagulant to “thin” your blood so it doesn’t clot as quickly. The FAA accepts most anticoagulants including aspirin, Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), or Eliquis (apixaban). Coumadin has been around a long time, and is a somewhat difficult drug to manage for several reasons. The FAA requires blood testing at least monthly to monitor your clotting times, and that requires a trip to the lab for the blood to be drawn.
With the newer medications—Pradaxa, Xarelto, and Eliquis—you should be stable for at least 30 days and tolerating the medications before providing any records to the FAA for special issuance consideration. You also will need a current report from your cardiologist. However, no regular blood testing is required with these medications.
Next time, I’ll discuss the interventional treatment options available to convert atrial fibrillation back to a regular rhythm.
AOPA Pilot Protection Services will be featuring topics related to the heart during the entire month of February. February is American Heart Month. Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day.