AFib

[snugs]

I'll try to be brief, 45 years old and healthy, have a 2nd class medical that expires 8/31/23. My commercial Checkride was scheduled for today, Thursday, 6/29. When I woke up Tuesday morning, my heart was acting weird. Went to the ER and was experiencing AFib. Lasted about 3 hours and went back into normal rhythm. They did bloodwork and took a chest x-ray and everything looked good. ER doctor sent me home and referred me to a cardiologist and told me to follow up with my family doctor. I self-grounded and cancelled my Checkride and I'm assuming I am grounded until further notice. Am I correct in assuming that? I called my AME's office and didn't really get any useful information from them. Any help or guidance would be appreciated.

 

[ebetancourt]

AFib is an SI that requires at least a Holter monitor and possibly a stress test. Perhaps some time as will. I really can't address the FAA with any real knowledge, I had an arrhythmia that required annual 24 hour Holter monitoring for about five years. Then the FAA said let us know if anything changes. More recently I had multiple AFib episodes that required an ER visit eventually, just kept lasting longer. Covid I suspect. My PCP referred me to a cardiologist specializing in Cardiac Electrophysiology. He did an ablation, and my heart now imitates a metronome. There are other solutions as well. Basic Med, my PCP signed me off six weeks after the ablation.

You need to find a really good AME. Bruce Chein got my SI for me. Hopefully he or one of the other AMEs will jump in.

 

[Stewartb]

https://www.faa.gov/ame_guide/special_iss/all_classes/afib

 

[lbfjrmd]

"I self-grounded and cancelled my checkride ... I'm assuming I am grounded until further notice?" Correct.

 

[craig d]

untreated OSA can be a causative factor in AF, with the SA under good control the AF goes away. the pilot I’m thinking about was taken off his AASI for AF and just reports the OSA now.

 

[snugs]

Thank you all for your responses. Looks like it will be a daunting road to get my commercial certificate.

 

[lbfjrmd]

Thank you all for your responses. Looks like it will be a daunting road to get my commercial certificate.

get your AF controlled and you certificate will be a piece of cake!

 

[Kenmore992]

Thank you all for your responses. Looks like it will be a daunting road to get my commercial certificate.

seriously it’s not the end of the world, there are many things that could have caused it, lack of sleep, stress, too much coffee, too much alcohol or a combination of any of those.

The SI is very obtainable, it took me 4 weeks to get it 10+ years ago, I was pretty aggressive with getting everything done. I had afib on Saturday, by Friday I had all the testing done and in the mail.

it has not kept me from doing anything

 

[Stewartb]

You can go BasicMed while you wait for the SI. Arrhythmias aren’t disqualifying under BasicMed.

 

[lbfjrmd]

You can go BasicMed while you wait for the SI. Arrhythmias aren’t disqualifying under BasicMed.

bad idea

 

[snugs]

Thanks for the reassuring comments. Unfortunately, I can't get in to see the cardiologist until the 1st week in August. Best I can tell it looks like I will need a 24 hr holter, nuclear stress test and sleep study to submit with the Initial Status Report. I'm hoping my AME will be able to help me navigate this.

 

[172andyou]

I self-grounded and cancelled my Checkride and I'm assuming I am grounded until further notice.

Wait, do you need a valid medical to do the checkride? I didn't think so. If my recollection is correct, and you're ready to do the ride, it might be worth doing it while your skills and training are still fresh. If I'm not, I'm sure someone will chime in?

 

[lbfjrmd]

another bad idea.

 

[Stewartb]

bad idea

Why? His issue appears to be resolved. He’ll wait months for an FAA doc to rubber stamp another doctor’s work.

Aeromed is a pita.

 

[snugs]

Wait, do you need a valid medical to do the checkride? I didn't think so. If my recollection is correct, and you're ready to do the ride, it might be worth doing it while your skills and training are still fresh. If I'm not, I'm sure someone will chime in?

I had hopes of being able to go ahead and get it done but a valid medical is a must. It'll have to wait until I can get this sorted.

 

[pmanton]

Afib can cause stroke. Happened to me.

 

[172andyou]

I had hopes of being able to go ahead and get it done but a valid medical is a must. It'll have to wait until I can get this sorted.

1) You have a valid medical.
2) I understood that you don't need to have one in any case. That as long as the examiner was willing to be PIC then you could do the ride without a medical of any sort.

 

[172andyou]

Ope, looks like it's been discussed here and I do have it wrong. https://www.pilotsofamerica.com/community/threads/medicals-and-checkrides.16457/

 

[Stewartb]

I’m an arrhythmia patient. My ER cardiology referral was next day. Got a stress test, echo, and had to wear a Holter with a link to a monitoring center with a call button night and day for 30 days. Not much fun but it turned out well. After several years I was sick of playing the SI game and after a long talk with my RFS went BasicMed. It doesn’t alter the management of my condition. In fact the new technology monitors me 24/7 and reports any unusual rhythm to my doc via an iPhone app. As far as cardiac care goes? This is a great time to be alive.

To the OP, don’t rely on your AME. Talk to your cardiologist. Most that I’ve met have pilot patients and are familiar with the FAA requirements. The AME will review your records and pass their work to aeromedical. I’d still have the aeromed requirements in hand for the cardiology visit just be make sure.

 

[snugs]

Ope, looks like it's been discussed here and I do have it wrong. https://www.pilotsofamerica.com/community/threads/medicals-and-checkrides.16457/

Yeah, my research led me to 61.23 which clears this up.

 

[snugs]

I’m an arrhythmia patient. My ER cardiology referral was next day. Got a stress test, echo, and had to wear a Holter with a link to a monitoring center with a call button night and day for 30 days. Not much fun but it turned out well. After several years I was sick of playing the SI game and after a long talk with my RFS went BasicMed. It doesn’t alter the management of my condition. In fact the new technology monitors me 24/7 and reports any unusual rhythm to my doc via an iPhone app. As far as cardiac care goes? This is a great time to be alive.

To the OP, don’t rely on your AME. Talk to your cardiologist. Most that I’ve met have pilot patients and are familiar with the FAA requirements. The AME will review your records and pass their work to aeromedical. I’d still have the aeromed requirements in hand for the cardiology visit just be make sure.

Very true. The technology is amazing.

I was definitely bummed to learn that I have to wait a month to see the cardiologist. The ER doc said he would "calculate my risk of stroke" and it was low, according to him. I'm assuming that is why he didn't expedite it. Hopefully, my GP can get me in quicker. My end goal is CFI so I will need to have a medical to get there.

 

[Kenmore992]

Often cardiologists are part of a big practice with several offices they circulate through.

I made myself available to go to any office at anytime to see the doctor, get the testing and follow up. They were able squeeze me in odd spots here and there to get it done.

You can call everyday and see if there are any cancellations, it’s not likely they will call you , you have to be your advocate.

 

[Kenmore992]

another thought, unless your AME is very comfortable with the process, it might be helpful to have another service or AME help you navigate the waters, some AMEs thrive on the more complicated stuff, others really don’t want to be bothered

I had access to medical consultants through my union and they incredibly helpful in putting the package together.

 

[bbchien]

Depending on your age, an ablation may be appropriate.
But the recert. path is:
Get good rate control.
Stress TMT to rule out Ischemic AFIB
Echo
24 hour rhythm monitor to demonstrate good rate control.

b

 

[snugs]

Often cardiologists are part of a big practice with several offices they circulate through.

I made myself available to go to any office at anytime to see the doctor, get the testing and follow up. They were able squeeze me in odd spots here and there to get it done.

You can call everyday and see if there are any cancellations, it’s not likely they will call you , you have to be your advocate.

Good idea. They do have multiple doctors and locations.

another thought, unless your AME is very comfortable with the process, it might be helpful to have another service or AME help you navigate the waters, some AMEs thrive on the more complicated stuff, others really don’t want to be bothered

I had access to medical consultants through my union and they incredibly helpful in putting the package together.

I'm not sure how comfortable my AME is with the process but I did schedule a consult with him. I'm thinking it might be best to skip that all together and go straight to someone that knows exactly what they're doing.

 

[snugs]

Depending on your age, an ablation may be appropriate.
But the recert. path is:
Get good rate control.
Stress TMT to rule out Ischemic AFIB
Echo
24 hour rhythm monitor to demonstrate good rate control.

b

That's good to know, thank you. From the Initial Status Report form I thought I was going to need a sleep study as well.

 

[bbchien]

That's good to know, thank you. From the Initial Status Report form I thought I was going to need a sleep study as well.

If you want to know get a home Sleep study, type 3. If the AHI is <5 you're healthwise in the clear. About $160 on your visa card, do it nonisnurance so it's jsut for you.

But if the AHI is >5, the linkage between untreated Sleep Apnea and AFib will return to bite your Right heart in the butt and your A Fib will recur, and recu, and recur even with a ablation.

 

[Kenmore992]

If you want to know get a home Sleep study, type 3. If the AHI is <5 you're healthwise in the clear. About $160 on your visa card, do it nonisnurance so it's jsut for you.

But if the AHI is >5, the linkage between untreated Sleep Apnea and AFib will return to bite your Right heart in the butt and your A Fib will recur, and recu, and recur even with a ablation.

Sounds interesting, do you have one that you recommend? The ones I have seen so far seem to have a vested interest in getting a positive result (they want to sell you treatments)

 

[WingmanMed]

We had a client's cardiologist say "the sleep study isn't indicated, I don't know why the FAA wants that so I'm not doing it."

Then we had to explain to the client that the cardiologist doesn't make the rules for FAA medical certification. And that maybe he should find a new cardiologist who knows there is a pretty good link between having untreated sleep apnea and atrial fibrillation.

 

[snugs]

If you want to know get a home Sleep study, type 3. If the AHI is <5 you're healthwise in the clear. About $160 on your visa card, do it nonisnurance so it's jsut for you.

But if the AHI is >5, the linkage between untreated Sleep Apnea and AFib will return to bite your Right heart in the butt and your A Fib will recur, and recu, and recur even with a ablation.

I'll be looking into that.

 

[snugs]

We had a client's cardiologist say "the sleep study isn't indicated, I don't know why the FAA wants that so I'm not doing it."

Then we had to explain to the client that the cardiologist doesn't make the rules for FAA medical certification. And that maybe he should find a new cardiologist who knows there is a pretty good link between having untreated sleep apnea and atrial fibrillation.

I'm afraid of that happening as well. Hopefully I can get the testing I need done without any pushback from the cardiologist.

 

[WingmanMed]

If you want to know get a home Sleep study, type 3. If the AHI is <5 you're healthwise in the clear. About $160 on your visa card, do it nonisnurance so it's jsut for you.

But if the AHI is >5, the linkage between untreated Sleep Apnea and AFib will return to bite your Right heart in the butt and your A Fib will recur, and recu, and recur even with a ablation.

Why recommend home Type III? An initial requires Type I or II. A Type III can rule in, but not out, sleep apnea for the purposes of the FAA.

 

[WingmanMed]

That's good to know, thank you. From the Initial Status Report form I thought I was going to need a sleep study as well.

For FAA purposes, an initial Afib workup does require a Type I or II sleep study.

 

[DFH65]

Not a doctor don't play one on TV nor did I stay at a Holiday Inn last night. These are my experiences. Sorry in advance for the novel.

AFIB is a pain in the butt as you never know when it is going to start and when it is going to stop. Some people don't even notice they are in AFIB. In my case I feel every premature beat and AFIB is/was very noticeable. Having said that it never stopped me from doing ordinary things I wasn't going to be running a marathon in AFIB but otherwise it was tolerable. I am on Basic Med but essentially did all the same tests the FAA would have required Holter/Stress (already on CPAP). They say AFIB begets AFIB for me it started out occasionally and then started happening more often so I had an ablation April 1st of '22. Since then while I still have the occasional premature beats I have not had a recurrence of AFIB. The ablation was pretty easy peasy but it isn't without risk. There are some new technologies that are coming online that have better tissue discrimination and less risk of collateral damage.

Now to the more practical things.
AFIB can be scary but in and of itself it isn't going to kill you (see comments on stroke below) one of the hard things is deciding when to go to the hospital. Obviously you have to decide for yourself but I only went to the hospital the first time. My thought was if I got close to 24 hours in AFIB I would call my cardiologist and discuss getting a cardioversion. I kept a log of every time I had AFIB when it started, when it stopped. Sometimes it lasted a few minutes the longest was almost 12 hours.

At least for me and for many I have read about it tends to start more at night. Sometimes laying on my left side would trigger it. There are other triggers too some people have mentioned food, alcohol, caffeine, over eating and some medications. I tried all sorts of things to make it stop when it started. Sometimes it worked sometimes not. The vagus nerve can be involved so they say stimulating it can help. Here are some things I tried to varying levels of success...try drinking ice cold water, try gagging yourself, try raising your heartbeat (seems counter intuitive) but this worked at times, try changing your position (lay down, stand up). You can ask your doctor to prescribe you a pill in the pocket (one you take when in an attack) like metoprolol. This can help but for me was hit or miss and I had a slowish resting heart rate to begin with (high 50s low 60s) and I hated how I felt when I took it (it lowers your heart rate) and occasionally had heart rate dropping into the 40s. As a side note my heart rate went up after the ablation (mid 70s now was 80s shortly after) which studies have shown is an indicator or success.

The big risk from AFIB is stroke. Research CHADVASC score and you will have a better understanding. Blood thinners may be prescribed. I was only on them prior to the ablation and then went off them 3 months after. I took Eliquis there was no way I was taking Warfarin and doing all the tests that go with that. There are programs where you can get Eliquis fairly inexpensively (https://www.eliquis.bmscustomerconnect.com/afib/savings-and-support) so don't get sticker shock when you first see the retail cost. Stroke risk can be associated with blood pooling then clotting in the left atrial appendage but AFIB from my research also seems to be not unlike high blood pressure an indicator of elevated stroke risk in certain people. I was leery of taking blood thinners as my brother died from a brain bleed on Warfarin but honestly I really didn't notice a big change with clotting on Eliquis it just took a little longer but not excessively. I would imagine when I get a little older and my CHADVASC score increases my cardiologist may recommend blood thinners again.

Best of luck to you. It is hard not to worry when it is your heart. Before my ablation I thought about AFIB all the time and stressed about going into it at inconvenient times. Now a year later the only time it creeps into my head is when I have the occasional premature heart beat but then the thought passes pretty quickly. If it comes back again I wouldn't hesitate to have another ablation.