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Atrial Fibrillation

Ask the Flight Surgeon / By CPT (Dr.) ) R. John Paul Gingerich:

Q: My brother was diagnosed with atrial fibrillation. What do you know about atrial fibrillation and what could it mean for me if I was diagnosed with it?

FS: Atrial fibrillation (AF) is a common heart problem which affects the rhythm of the heart. Commonly referred to as “A. Fib,” it affects over 2 million people in the Unites States. In 2019, nearly 150 cases of AF were diagnosed in Active-Duty service members.

What causes Atrial Fibrillation?

The heart has four chambers: two atria and two ventricles, which are sometimes referred the “upper” and “lower” chambers, respectively. The chambers normally squeeze in series, first the upper, then the lower. The heart is essentially a pump with four moving parts.

The heart normally works by sending electrical signals from the top of the heart to the bottom in a very specific time and route, this is what causes the rhythmic pumping function of the heart. With AF, the signals are not sent properly, causing abnormal movement of the heart. Unlike the rhythmic effective pumping, the atria quiver with little to no movement, as whole. This results in decreased amount of blood pumped through the heart to the body.

Although AF can happen to anyone, there are some recognized risk factors which make it more likely to occur. Among the most common risk factors are genetic predisposition, uncontrolled high blood pressure, older age, male gender, and European ancestry.

Why is Atrial Fibrillation a Problem?

The decreased pump efficiency results in turbulent flow of blood or stagnant blood, likely allowing blood to clot. If a clot is dislodged and allowed to travel, it could block the blood flow to various organs. Although many organs are susceptible, most notable organ is the brain. A stroke occurs when the blood clot blocks an artery which supplies part of the brain, depleting oxygen supply. A stroke is a catastrophic event for anyone, let alone an aviator in flight.

The second concern is the rapid heart rate which AF can cause. At the very least, it can be frightening to the individual, but at worst it can cause instability of the blood flow from the heart and even cause death.

Symptoms

The symptoms differ from person to person, and it is possible to have no symptoms at all. While many cases of AF are found incidentally on an electrocardiogram (ECG), common symptoms are fast heartbeat while resting, dizziness, fatigue, or even mild chest pain.

Treatment

There are several options for treating atrial fibrillation. Anticoagulants or “blood thinners” are used to prevent the clots from forming in the heart, which decreases the chance of stroke. Other medicines can control the heart rate by slowing it down. If medicines do not work, a routine procedure which very precisely burn (called radio ablation) small areas of the heart which are thought to cause AF could be performed. Finally, if other methods fail, some people with AF require a pacemaker to control the rate of their heart. A pacemaker is a small device implanted under the skin which sends electrical signals to the heart, regulating the pace. With specific and proper treatment for atrial fibrillation, many people live effective lives with little limitations.

What are the Army Regulations Regarding Atrial Fibrillation?

Army Regulation 40-501: paragraph 3-14b supraventricular tachyarrhythmias states that a Soldier with AF should be referred to the Disability Evaluation System (DES), but not necessarily discharged from the Army.

The primary concern regarding Aviation duties is the risk that AF poses for sudden incapacitation in the form of a stroke, a catastrophic event, especially under the circumstances of Aviation. AR 40-501, paragraph 4-12b(10) lists atrial fibrillation among conditions that do not meet the standards of medical fitness for flying duty. The Aeromedical Policy Letters (APL) states that waivers may be considered for those who have undergone the radio ablation. Six months after successful treatment with radio ablation, a waiver may be applied for. However, it should be noted that those with other underlying conditions such as coronary artery disease (CAD), and in those who have a recurrence of the atrial fibrillation, it is highly unlikely that a waiver will be granted.

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If you have a question you would like addressed, email it to This email address is being protected from spambots. You need JavaScript enabled to view it.; we will try to address it in the future. See your unit flight surgeon for your personal health issues.

The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.

-----
Dr. (CPT) R. John Paul Gingerich is a flight surgeon and Resident in Aerospace Medicine the U.S. Army School of Aviation Medicine at Fort Rucker, AL.

What causes Atrial Fibrillation?

The heart has four chambers: two atria and two ventricles, which are sometimes referred the “upper” and “lower” chambers, respectively. The chambers normally squeeze in series, first the upper, then the lower. The heart is essentially a pump with four moving parts.

The heart normally works by sending electrical signals from the top of the heart to the bottom in a very specific time and route, this is what causes the rhythmic pumping function of the heart. With AF, the signals are not sent properly, causing abnormal movement of the heart. Unlike the rhythmic effective pumping, the atria quiver with little to no movement, as whole. This results in decreased amount of blood pumped through the heart to the body.

Although AF can happen to anyone, there are some recognized risk factors which make it more likely to occur. Among the most common risk factors are genetic predisposition, uncontrolled high blood pressure, older age, male gender, and European ancestry.

Why is Atrial Fibrillation a Problem?

The decreased pump efficiency results in turbulent flow of blood or stagnant blood, likely allowing blood to clot. If a clot is dislodged and allowed to travel, it could block the blood flow to various organs. Although many organs are susceptible, most notable organ is the brain. A stroke occurs when the blood clot blocks an artery which supplies part of the brain, depleting oxygen supply. A stroke is a catastrophic event for anyone, let alone an aviator in flight.

The second concern is the rapid heart rate which AF can cause. At the very least, it can be frightening to the individual, but at worst it can cause instability of the blood flow from the heart and even cause death.

Symptoms

The symptoms differ from person to person, and it is possible to have no symptoms at all. While many cases of AF are found incidentally on an electrocardiogram (ECG), common symptoms are fast heartbeat while resting, dizziness, fatigue, or even mild chest pain.

Treatment

There are several options for treating atrial fibrillation. Anticoagulants or “blood thinners” are used to prevent the clots from forming in the heart, which decreases the chance of stroke. Other medicines can control the heart rate by slowing it down. If medicines do not work, a routine procedure which very precisely burn (called radio ablation) small areas of the heart which are thought to cause AF could be performed. Finally, if other methods fail, some people with AF require a pacemaker to control the rate of their heart. A pacemaker is a small device implanted under the skin which sends electrical signals to the heart, regulating the pace. With specific and proper treatment for atrial fibrillation, many people live effective lives with little limitations.

What are the Army Regulations Regarding Atrial Fibrillation?

Army Regulation 40-501: paragraph 3-14b supraventricular tachyarrhythmias states that a Soldier with AF should be referred to the Disability Evaluation System (DES), but not necessarily discharged from the Army.

The primary concern regarding Aviation duties is the risk that AF poses for sudden incapacitation in the form of a stroke, a catastrophic event, especially under the circumstances of Aviation. AR 40-501, paragraph 4-12b(10) lists atrial fibrillation among conditions that do not meet the standards of medical fitness for flying duty. The Aeromedical Policy Letters (APL) states that waivers may be considered for those who have undergone the radio ablation. Six months after successful treatment with radio ablation, a waiver may be applied for. However, it should be noted that those with other underlying conditions such as coronary artery disease (CAD), and in those who have a recurrence of the atrial fibrillation, it is highly unlikely that a waiver will be granted.

If you have a question you would like addressed, email it to This email address is being protected from spambots. You need JavaScript enabled to view it.; we will try to address it in the future. See your unit flight surgeon for your personal health issues.

The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.

-----

Dr. (CPT) R. John Paul Gingerich is a flight surgeon and Resident in Aerospace Medicine the U.S. Army School of Aviation Medicine at Fort Rucker, AL.

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