Atrial fibrillation, or Afib, is one of the most common heart problems that health care providers treat. (See “Rhythm of My Heart,” AOPA Pilot magazine, August 2018, page 26.) More prevalent in an older population, Afib is an arrhythmia that results in unsynchronized electrical conduction that inhibits proper contraction of the upper chamber of the heart. But, for FAA medical certification or BasicMed qualification purposes, is Afib considered to be “coronary heart disease”?
For operations requiring a medical certificate, FAR 67.111; .211; and .311 disqualify a history of “coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant.” Coronary “heart” disease and coronary “artery” disease are terms used interchangeably in clinical and regulatory circles and refer to obstructive disease in the arterial systems that supply blood to the heart muscle via the left anterior descending, circumflex, and right coronary arteries, the three main vessels that branch off the left main coronary artery. It’s a “plumbing problem” rather than an electrical issue.
So when the discussion of coronary artery disease (CAD) comes up, it is usually in the context of disease that results from the accumulation of plaques (“lesions”) in the arterial supply system that jeopardizes heart muscle (myocardium) viability. When the heart doesn’t have good blood supply, bad things can happen, including myocardial infarction, another of the specific disqualifying conditions found in the cardiovascular section of Part 67 that requires a special issuance authorization. Symptomatic heart disease can manifest with “angina pectoris,” or chest pain, fatigue, shortness of breath, or pain radiating to the jaw or arms, and it can be present at rest or with exertion. These are symptoms worthy of your attention, so don’t ignore them as they may be signals of an impending cardiac event.
When the regulation refers to heart disease that required “treatment,” it’s referring to intervention that revascularizes the jeopardized myocardium to restore blood supply. Typically, interventional treatment includes angioplasty with stent placement or coronary artery bypass grafting. For operations that require a Part 67 medical certificate, there is a process to obtain a special issuance authorization.
Under BasicMed, there are four heart conditions that require a one-time special issuance before you can operate under the BasicMed regulations: coronary heart disease that has required treatment, as noted above; a myocardial infarction (heart attack); heart valve replacement; and heart replacement (transplant).
Now, with all that background we can get back to the topic of Afib. Like other arrhythmias, Afib is more of an electrical conduction issue and is not considered to be heart disease in the regulatory sense but is considered under the “general medical condition” section of Part 67. The diagnosis still requires a special issuance medical authorization for operations that require a medical certificate. However, for operations under BasicMed, Afib that is well controlled and followed by your treating physician does not require prior special issuance consideration by the FAA.