Electrocardiographic abnormalities in medically screened German military aircrew

A resting electrocardiogram (ECG) is a well-tolerated, non-invasive, and inexpensive test for overt electrical signs of cardiac pathology and is widely used in the screening of aircrew and other high-hazard occupations. Given the low number of pathological results leading to disqualification or restriction however, there is an ongoing debate as to how often screening ECGs should be performed in different age groups.

We restrospectively analyzed 8275 resting 12-lead ECGs registered between 2007 and 2020 in the German Air Force Centre of Aerospace Medicine. Findings were categorized according to consensus recommendations published by the NATO Working Group on Occupational Cardiology in Military Aircrew, based on ECG screening criteria published for athletes which were used at the time of registration. Age, sex, height, weight, and body mass index of the probands were also captured. Additionally, 4839 pilot and non-pilot aircrew members were analyzed longitudinally over a maximum period of 13.4 years.

Out of all the ECGs only 18 revealed findings requiring further investigation, and only one individual was temporarily disqualified because of a ventricular pre-excitation (delta wave) as a sign of an antegrade conducting accessory pathway. The longitudinal analysis of 25,829 ECGs revealed 28 abnormalities requiring further investigation, and only two ECG findings (in probands aged 48.8 and 59.1 years) led to temporary, or permanent disqualification. In a third case, the ECG showed signs of a myocardial infarction, which was already known from the proband's history.

Initial ECG screening for asymptomatic aircrew revealed extremely low numbers of individuals requiring further investigation in our cohort. This would appear to justify an initial screening ECG and follow-up ECGs at certain intervals starting at a certain age, but routine ECG screening of applicants in professions with a higher risk tolerance or frequent, e.g. annual, follow-up ECGs in younger aircrew is not supported by our data because of the minimal yield of ECG findings requiring further investigation.