You will recall that last time we talked generally about atrial fibrillation and how it is treated. In this installment, we will discuss other treatment options your cardiologist may suggest if you are found to be in atrial fibrillation.
In many cases, the first health care provider seen is a treating physician through the emergency room; the physician will initially treat the patient with an intravenous medication to slow the electrical impulse through the AV node that I mentioned in the previous article. If that is successful, the patient will be placed on an oral version of the drug, plus an anticoagulant medication to prevent blood clotting. If the drug therapy establishes a regular heart rhythm, for medical certification purposes the FAA will want the pilot to be on the medication regimen for about 30 days. After that, the pilot can apply for special issuance by providing a report from the treating doctor as to what happened, what medication is being taken, and the results of a current 24-hour Holter monitor.
The Holter monitor records heart rate and rhythm through leads attached to the chest that are connected to a small recording device. When the monitoring period is over, the recorded data is downloaded and printed.
When the monitor is hooked up, the patient will be given a diary and asked to record activities hourly during the time the monitor is recording. The patient should write something down each hour he or she is awake but especially when exercising, urinating, having a bowel movement, having sex, going to sleep, waking up, etc. (For example: 5 a.m. woke up, 7 a.m. went for a 30-minute walk.) I cannot emphasize enough how important it is to maintain this diary! The doctors who review this test will compare the time in the diary with what the heart rhythm did at the same time. The printout of the data will include “representative tracings.” The FAA will want to see these and all the other “raw data” that is generated to get a good picture of how the heart behaved during the monitoring period.
Another treatment that is offered to get someone back in their regular heart rhythm is called a cardioversion. This procedure involves mild sedation and a low-voltage electric shock to put the heart back into a regular rhythm. The FAA requires pilots to be grounded for 90 days after this treatment and then to provide the report from their cardiologist and a 24-hour Holter monitor.
Another treatment is a radiofrequency catheter ablation, which utilizes radio frequency waves to disrupt or disconnect the pathways where these abnormal rhythms are occurring. The FAA requires pilots to be grounded for 90 days after this procedure as well. These periods of grounding are done to see whether the heart is going to go back into the atrial fibrillation. The requirements for special issuance consideration are the same here as well.