Table 4

Recommendations for bradyarrhythmias and conduction disturbances

Symptomatic sinus bradycardia—asymptomatic pauses >3 s during daytime and >4 s at night; a newly discovered first degree atrioventricular (AV) block with a PR interval >300 ms—should, at least temporarily, lead to withdrawal of flying privileges.Highly recommended
Asymptomatic sinus bradycardia—first degree AV block up to a PR interval of 300 ms; and second degree (Mobitz type I) AV block—is most likely caused by an increased vagal tone and does not require further investigation.Highly recommended
Aircrew with complete right bundle branch block should undergo cardiological evaluation to exclude an underlying disease. Over age 40, coronary assessment may be considered. In the case of normal results an unrestricted fit assessment is possible.Recommended
Aircrew with complete left bundle branch block should initially be assessed as unfit and undergo thorough cardiological evaluation. Under age 40, a coronary assessment should be considered; over age 40, it is recommended. If an underlying disease can be excluded, return to unrestricted aircrew duties may be possible, with regular (annual) follow-ups.Recommended
Unrestricted flying with left anterior fascicular block (LAFB) and left posterior fascicular block (LPFB) is possible, if there is no evidence of an underlying cardiac disease. In the case of newly acquired LAFB or LPFB, over the age of 40 years, coronary artery disease should be excluded.Recommended
Aircrew requiring implanted pacemakers are initially unfit for aircrew duties. If individuals are not pacemaker dependent, lead systems are bipolar and appropriately programmed, and regular pacemaker follow-ups are performed, a return to aircrew duties may be possible based on an appropriate risk assessment. For military and commercial pilots, restricted flying, with a second qualified pilot, is recommended,Recommended
Second degree AV block (Mobitz type 2), and third degree AV block require a full cardiological evaluation and are usually incompatible with aircrew duties. They may require pacemaker management and return to aircrew duties should be considered on a case by case basis and will be dependent on aircrew role.Not recommended