Cardiac Rhythm and Conduction Abnormalities in Aircrew

Cardiac rhythm and conduction abnormalities are common findings in aircrew and are a frequent cause of a loss of flying privileges. Given the great variety of electrophysiological disorders, risk assessment is challenging for the aviation medical examiner. For aeromedical assessment, important aspects of an electrophysiological evaluation are the presence or absence of symptoms and prognosis of the arrhythmia. In young fit people with increased vagal tone, some abnormal electrocardiogram findings are acceptable and do not require further investigation.

This article provides recommendations for a stepwise screening approach and enhanced investigation of rhythm and conduction abnormalities for those which increase the risk to flight safety. Four cases of common arrhythmias are presented, namely premature ventricular complexes, nonsustained ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation. The most important factors for the aviation medical examiner regarding evaluation, treatment, and aeromedical assessment will be provided in a brief discussion of each case.

This paper presents the current benchmark for assessing aircrew with rhythm and conduction abnormalities with data derived from current aeromedical and clinical literature, as well as the expert consensus of the NATO Working Groups on Occupational Cardiology (HFM WG 251, 316). Guettler N, Holdsworth D, Broekhuizen L, Syburra T, D'Arcy J, Bron D, Manen O, Davenport E. Cardiac rhythm and conduction abnormalities in aircrew. Aerosp Med Hum Perform. 2026; 97(4):289-295.