Denied for PVCs

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PVC

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My 3rd class medical was denied "due to your history of frequent (27%) Premature Ventricular Contractions (PVCs)."

The AME deferred to the FAA after noting an irregular heartbeat and the FAA requested a 24-hour Holter monitor report and a stress test.

Stress test: Completed 4 stages to 105%, PVCs decreased during peak exercise, findings normal. Duke score =12 (low risk).

24-hr Holter monitor: sinus rhythm, no atrial fibrillation, no bradycardic episodes, no pauses, no ventricular tachycardia, total of 3 premature atrial ectopic beats, 26,800 premature
ventricular ectopic beats, 544 ventricular couplets, and 3 ventricular triplets. PVC burden: 27%. HR 53-121 bpm, mean; 68 bpm.

All labs are within normal limits.

Most recent echocardiogram was 5 years ago and EF LV was 60%. I've no reason to think it's different now.

I've had PVCs all my life (age 51), never fainted, I don't get winded or dizzy going up the stairs. BP averages about 125/78. My most recent medical was some 20 years ago and I want to get back to flying again.

The denial letter states that for reconsideration I need to submit a report which includes "demonstrated control of your frequent PVCs" and another 24-hr Holter monitor study which "should show less than 10% PVC burden."

I could not find any FAA material showing a denial/approval threshold for PVCs, so the FAA doctor must think I'm at high risk for incapacitation?

The denial letter also states that the FAA will consider my application withdrawn unless I make an application for reconsideration "within 30 days of this action." Two weeks have already passed from the letter's date - I received it yesterday. Can I ask for an extension?

My next step is to talk to the cardiologist about this, but I would like to gain a better understanding of the issue from the pilot community's perspective.

Thank you for any input and I apologize for the information dump here - this is weighing heavily on me.
 
Hopefully you will get approved and then go Basic med.
 
I have no idea about thresholds
but I'd call AOPA's medical team for advice ASAP.

I'm about your age, and the same...asymptomatic PVC's. I have no idea though about my counts but I'm guessing lower and less frequent...
I went through almost exactly the same thing back maybe 25 years ago....holter monitor back in those days was quite a big thing. Stress test, echo.... I was cleared but had to go back for another stress test and echo some time later..... at my next medical I think it was. Asymptomatic and benign was the final word.... nothing more required.

I hope for the same for you!
 
Modern cardiology is amazing. My cardiologist is one of my heroes. If you can find a cardiologist who’s familiar with the FAA and/or has other pilot patients your path will be easier to navigate. My pirep.
 
?
just guessing here....

does discompaction syndrome ring any bells?
How about RVOT syndrome?
 
bbchien said:
does discompaction syndrome ring any bells?
How about RVOT syndrome?
Click to expand...

They don't ring any bells.

I had a visit with the electrophysiologist and he assured me that what I have is not associated with sudden death or incapacitation. His notes from the visit state "Morphology most consistent with
right ventricular outflow tract PVC focus. In general this is a benign diagnosis." According to the cardiologist, the right ventricular outflow tract (RVOT) is the most common origin of ventricular arrhythmias.

The cardiologist seemed fairly confident that medication (Verapamil) alone could achieve the PVC burden, so we'll see how that goes.

AOPA recommends keeping communication open and sending the FAA a letter asking for an extension and explaining that I am working with a cardiologist to correct the health condition.

As for the acceptable PVC burden, I came across an FAA presentation from 2018 that says less 20% on a Holter monitor study is acceptable. I don't know why they are asking me to go below 10%. See page 56: https://civilavmed.org/wp-content/uploads/2020/09/Cardiology-Miller-09-2018.pdf
 
I've read that low potassium or magnesium can be a factor in causing PVC's. Bananas, potatoes, and other fruits and vegetables are good sources of those minerals.
 
Have you had the EP mapping to determine you don’t have the malignant type of RVOT VPCs? That’s likely why the want you down to 10%.
Is your cardiologist an EP (electrophysiologist)?
 
Yes, the cardiologist is an EP. No EP mapping.

So far my test results and ECGs have been seen by 4 heart doctors: two "regular" cardiologists, an EP cardiologist, and a cardiac surgeon. None have expressed any concern over my diagnosis. The surgeon called it "garden variety."
 
I'm closing this topic with some good news - I've received a 3rd class medical with special issuance.

To maintain the medical the FAA wants an annual 24-hr Holter monitor study and a report from a cardiologist for the next six years, but I'll skip that and go Basic Med.

The verapamil seems to have done the job: PVCs went from 27% burden on the first Holter study to 3% on a repeat study. The echocardiogram was normal, as expected. In the end, no structural or ischemic heart disease and I remain asymptomatic.

It took over a year and $3,000 to satisfy the bureaucracy.
 
PVC said:
My 3rd class medical was denied "due to your history of frequent (27%) Premature Ventricular Contractions (PVCs)."

The AME deferred to the FAA after noting an irregular heartbeat and the FAA requested a 24-hour Holter monitor report and a stress test.

Stress test: Completed 4 stages to 105%, PVCs decreased during peak exercise, findings normal. Duke score =12 (low risk).

24-hr Holter monitor: sinus rhythm, no atrial fibrillation, no bradycardic episodes, no pauses, no ventricular tachycardia, total of 3 premature atrial ectopic beats, 26,800 premature
ventricular ectopic beats, 544 ventricular couplets, and 3 ventricular triplets. PVC burden: 27%. HR 53-121 bpm, mean; 68 bpm.

All labs are within normal limits.

Most recent echocardiogram was 5 years ago and EF LV was 60%. I've no reason to think it's different now.

I've had PVCs all my life (age 51), never fainted, I don't get winded or dizzy going up the stairs. BP averages about 125/78. My most recent medical was some 20 years ago and I want to get back to flying again.

The denial letter states that for reconsideration I need to submit a report which includes "demonstrated control of your frequent PVCs" and another 24-hr Holter monitor study which "should show less than 10% PVC burden."

I could not find any FAA material showing a denial/approval threshold for PVCs, so the FAA doctor must think I'm at high risk for incapacitation?

The denial letter also states that the FAA will consider my application withdrawn unless I make an application for reconsideration "within 30 days of this action." Two weeks have already passed from the letter's date - I received it yesterday. Can I ask for an extension?

My next step is to talk to the cardiologist about this, but I would like to gain a better understanding of the issue from the pilot community's perspective.

Thank you for any input and I apologize for the information dump here - this is weighing heavily on me.
Click to expand...
I had 1% PVC and still have not been approved. 13 months and counting
 
Were you denied because of the PVCs or something additional? Did the FAA give you a number to shoot for in your test results? They were pretty specific with my guideline: demonstrated control of PVCs and <10% burden.
 
Glad it worked out for you. I'm 71, been flying for decades but mostly sailplanes so no medical required. PVCs came out of nowhere this year, messing up my sleep to the point of unrecognized apnea. I soon realized something was wrong, being low on final, apparently from a momentary sleep, and after that day the choking in bed sensations began. So I immediately stopped piloting even before a diagnosis. When my GP saw me he panicked but the cardiologist was not so concerned. It took some work and a lot of testing to find the right Rx, which is Flecainide. I can sleep fine and it reduced the PVCs to 20% and can feel the irregular beats on and off. The cardio specialists agree that this shouldn't interfere with my lifespan but the drug is not on the FAA approved list and that % is still high. I suppose a special issue is possible, but given the time and expense involved, plus the years left for flying, I'd say it's time to hang things up. Too bad, but better a little early than too late. Hope all is of some use to another looking for information.
 
I'm on BasicMed. but have had arrhythmia for a long time. Mostly infrequent, on an SI years ago. After Holter for five years was cleared. Last December it suddenly became very frequent (PVCs, wide QRS and aFib) and I self-grounded. My PCP sent me to a cardiologist specializing in arrhythmias. An ablation two weeks ago, one night in hospital. Sinus rhythm ever since. No restrictions after first week. Magic!
 
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