Cardiac effects of anthracycline treatment and their implications for aeromedical certification

In 1997 an autopsy on a professional pilot killed in an aircraft accident demonstrated myocardial fibrosis, thought to be the result of previous anthracycline treatment. The United Kingdom (UK) Civil Aviation Authority (CAA) was tasked with investigating the possible dangers to flight safety of treatment with this type of chemotherapy.

From CAA computer records of 18,319 professional license holders, 14 were identified as having received anthracycline treatment. These subjects underwent clinical cardiological examination, exercise and 24 h ambulatory electrocardiography, and echocardiography. Other studies were performed as needed.

Of the 14 subjects, 9 demonstrated arrhythmias on ambulatory electrocardiography, including 4 with ventricular tachycardia and 5 with supraventricular tachycardia, a much higher incidence than expected. One pilot had evidence of left ventricular dysfunction and another developed symptomatic sinus arrest at first follow-up. Another died shortly after completing the investigations from acute lymphatic leukemia, probably a complication of his original chemotherapy for Hodgkin's disease. In this small cohort there seemed to be no correlation of abnormal findings with anthracycline dose nor with time since completion of treatment.

The results presented strongly suggest the need for cardiological review of individuals who have received anthracycline treatment and who are seeking initial certification or recertification for professional aviation licensing.