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Decadal electrocardiographic changes between age 40 and 50 in military pilots
Nobuhiro Ohrui1, Tetsuya Hisada, Yukiko Tsujimoto
1Aeromedical Laboratory, Japan Air Self-Defense Force, Tachikawa, Tokyo, Japan. orui1690@inet.asdf.mod.go.jp
Insights
Decadal electrocardiogram (ECG) changes in pilots aged 40-50 are mostly normal variants. However, hypertensive pilots with ECG abnormalities require further cardiovascular evaluation, including echocardiography, to detect potential cardiac conditions.
Area of Science:
- Aviation Medicine
- Cardiology
- Aerospace Physiology
Background:
- Cardiovascular diseases pose risks for pilot incapacitation and disability.
- Electrocardiogram (ECG) is crucial for screening pilot cardiovascular health.
- Certain ECG changes may indicate underlying structural heart disease or new conditions like Brugada syndrome.
Purpose of the Study:
- To analyze decadal ECG changes in aircraft pilots aged 40 to 50 years.
- To evaluate the significance of these ECG changes in aeromedical examinations.
- To inform appropriate risk assessment for pilots.
Main Methods:
- Compared ECGs of 176 Japan Air Self-Defense Force pilots at age 40 versus age 50.
- Analyzed annual aeromedical examination data.
- Conducted echocardiography for selected pilots with ECG changes.
Main Results:
- Identified 34 new ECG changes, including sinus bradycardia, left axis deviation, and left ventricular hypertrophy (LVH).
- Most changes were considered normal variants.
- Echocardiography revealed hypertrophic cardiomyopathy and heart enlargement in two hypertensive pilots with uncontrolled blood pressure.
Conclusions:
- Recommends further cardiovascular assessment for hypertensive pilots exhibiting ECG changes.
- Highlights the importance of echocardiography in evaluating pilots with specific ECG findings.
- Suggests a need for tailored screening protocols based on ECG results and medical history.
Introduction:
Cardiovascular diseases can lead to sudden in-flight incapacitation and long-term disability in aircraft pilots. Electrocardiogram (ECG) has been widely used to screen for these diseases in routine aeromedical examinations. Several ECG changes such as complete left bundle-branch block (CLBBB) and left ventricular hypertrophy (LVH) have been associated with increased likelihood of underlying structural cardiac diseases in addition to the emergence of newly recognized cardiovascular diseases such as Brugada syndrome. Therefore, the purpose of this study was to analyze decadal ECG changes in aircraft pilots between 40 and 50 yr in order to make an appropriate evaluation of these ECG changes.
Methods:
We analyzed the ECGs from the annual aeromedical examination of age 50 compared to those 40 yr of age in a total of 176 Japan Air Self-Defense Force pilots.
Results:
With regard to decadal changes, we detected 34 new ECG changes (1 of sinus tachycardia, 8 sinus bradycardia, 1 atrial fibrillation, 2 premature atrial contraction, 1 premature ventricular contraction, 2 left axis deviation, 6 first-degree atrioventricular block, 1 CLBBB, 3 complete right bundle-branch block, 2 incomplete right bundle-branch block, 1 right ventricular conduction delay, and 6 LVH). Although the majority of them were concluded to be normal variants, the results of echocardiography in two hypertensive pilots without good control demonstrated abnormalities: one had mild hypertrophic nonobstructive cardiomyopathy and another had heart enlargement.
Conclusion:
Thus, this study recommends additional cardiovascular examinations, including echocardiography for hypertensive pilots with ECG changes.
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