Atrial fibrillation presented with syncope in a jet pilot during daily briefing on squadron

Syncope may be the initial clinical presentation of atrial fibrillation (AF) and has a great potential for incapacitation during flight. Herein is presented the case of a jet pilot who had paroxysmal palpitations accompanied with presyncope which progressed to syncope and was found to be associated with AF.

A 23-yr-old male jet pilot had a sudden syncope at the fifth minute of his presentation during the daily flight briefing. After he regained consciousness, he was transferred to the intensive care unit of the military hospital. His medical history revealed two episodes of syncope which resulted in spontaneous recovery and were not reported to the flight surgeon. He had no abnormal findings on his physical examination except heart rate, which was irregular and 110 bpm with a rapid ventricular response. His diagnosis was AF. Laboratory tests, including thyroid hormones, CBC, transthoracic echocardiography, ultrasonography of the abdomen, chest X-rays, and also a tilt table test, were normal. He had completely normal findings on 24-h ECG Holter monitoring except rare ventricular extrasystoles and had a negative treadmill stress test. AF spontaneously converted to sinus rhythm during the follow-up in the intensive care unit. He was temporarily grounded and returned to flying duties after a 3-mo follow-up period without any recurrent arrhythmia.

Syncope has various mechanisms and etiologies, and also a benign prognosis on the ground. However, not only vasovagal syncope, but also AF may be among the frequent causes of syncope in aviators and pilots, as was the case in the current study.