AFIB in the aging pilot need help

[riobison]

Gents,
Im 69 yrs of age and a private pilot here in Canada. With my new Pixel Watch I have found out that I have paroxysmal afib and its rate controlled on its own at 75+- bpm and I don't even know I have it unless I look at my watch or it notifies me and I see my resting pulse has gone from a 62 to a 75 or so. I'm still into the gym wt training, cardio and hard core Cross Country Skiing. In short I've been a athlete all my life and still in excellant shape for my age except for this. And yes I have passed all of the tests, Carotid ECG, Echo, Holter, Stress test etc. Labs are perfect etc. When I go into AFIB its only for a few hrs or a day or so and it pops out on its own.

As to be expected they won't renew my medical.

2 cardiologists have told me it won't kill me nor leave me incapacitated. I do take aphixabahn twice a day to prevent clots. Lots of people have it and are never treated for this type unless it impacts their life. I'm on a waiting list and its 2 yrs out as mine isn't life threatening.

I was prescribe Pill in the Pocket (Flecainide) they have made it clear that's out. I've never even used it and can take the pills back so the Dr can count them for Transport Canada.

TC wants a plan on what we are going to do. That means monitoring me, continue with the Apixaban etc. I have asked them directly what else they suggest but they refuse to guide me on what's acceptable and only on what's not acceptable. A real waste of time and resources for everyone. Even the doctors are shaking their heads on this.

Any suggestions or what to propose for a plan short of quit flying? I'm assuming that things will be similar in the US and is why I'm reaching out.

Thanks

 

[GerryWA]

Gents,
Im 69 yrs of age and a private pilot here in Canada. With my new Pixel Watch I have found out that I have paroxysmal afib and its rate controlled on its own at 75+- bpm and I don't even know I have it unless I look at my watch or it notifies me and I see my resting pulse has gone from a 62 to a 75 or so. I'm still into the gym wt training, cardio and hard core Cross Country Skiing. In short I've been a athlete all my life and still in excellant shape for my age except for this. And yes I have passed all of the tests, Carotid ECG, Echo, Holter, Stress test etc. Labs are perfect etc. When I go into AFIB its only for a few hrs or a day or so and it pops out on its own.

As to be expected they won't renew my medical.

2 cardiologists have told me it won't kill me nor leave me incapacitated. I do take aphixabahn twice a day to prevent clots. Lots of people have it and are never treated for this type unless it impacts their life. I'm on a waiting list and its 2 yrs out as mine isn't life threatening.

I was prescribe Pill in the Pocket (Flecainide) they have made it clear that's out. I've never even used it and can take the pills back so the Dr can count them for Transport Canada.

TC wants a plan on what we are going to do. That means monitoring me, continue with the Apixaban etc. I have asked them directly what else they suggest but they refuse to guide me on what's acceptable and only on what's not acceptable. A real waste of time and resources for everyone. Even the doctors are shaking their heads on this.

Any suggestions or what to propose for a plan short of quit flying? I'm assuming that things will be similar in the US and is why I'm reaching out.

Thanks

Ask this guy, he seems to know everthing about the US medical stuff which probably parallels what you run into up north. anyway that’s probably your best bet asking somebody that could you from a medical standpoint.

Learn about Flight Physicals by Dr. Bruce Chien; Bolingbrook, IL

Dr. Bruce Chien in Bolingbrook, IL offers FAA Medical Exams required for Pilots & Air Traffic Controllers. Learn more about the exam and this clinical practice.

flightphysical.com

 

[scorwin]

First, big breath. You will get through this.
Second. A-fib is incredibly common. Surely, someone at Transport Canada has helped someone with this. Ask around. Call another CAME. If TC is asking "you" what the next step is, you need to talk to someone else.
Third. You have likely had this for a while, after being seen by 2 cardiologist and the battery of tests performed. If you're on Apixiban, you must have some risk factors (Chads-VASC), otherwise you would be on Aspirin. The work up has been completed and should make for a quicker resolution.
Lastly. FAA on our southern side of the street has a clear path. I'm not familiar with the northern side, so reaching out like you have just done is a great step. Search on different forums and reddit. Don't give up and don't be shy. This is why pilots don't tell the whole truth on pilot exams. It's frustrating on both sides (pilot and physician examiners).
Source: ED Physician for 20 years, soon to be AME for this reason.

 

[Ironflight]

I can’t help you with TC, but maybe I can encourage you by telling you that I know of active astronauts that have been treated for A-fib using Ablation and returned to flying status - and that is both for atmospheric and exo-atmospheric flight! If they can do it with astronauts, they can do it with private pilots….. so hang in there, learn more about it with the links above, and find an advocate that can guide you through. At least we can do that in the US and although painful in the short term, it pays off in the long run by getting folks back in the air.

 

[Chukill]

Fly light sport?

 

[MacCool]

Fly light sport?

In both US and Canada he'd still need approval after an FAA or TC-directed cardiac workup. A new cardiac event like that in someone with an FAA medical or Basic Med = grounded until cleared. In the US, that would mean getting a Class 3 and Special Issuance.

Paul's right...there are many pilots flying with a-fib, but the government wants to know about it and approve on a case-by-case basis.

 

[Dugaru]

In both US and Canada he'd still need approval after an FAA or TC-directed cardiac workup. A new cardiac event like that in someone with an FAA medical or Basic Med = grounded until cleared. In the US, that would mean getting a Class 3 and Special Issuance.

Paul's right...there are many pilots flying with a-fib, but the government wants to know about it and approve on a case-by-case basis.

Not sure that's true in the US if you're already on BasicMed, per AOPA:

Under BasicMed, there are four heart conditions that require a one-time special issuance before you can operate under the BasicMed regulations: coronary heart disease that has required treatment, as noted above; a myocardial infarction (heart attack); heart valve replacement; and heart replacement (transplant).

... Like other arrhythmias, Afib is more of an electrical conduction issue and is not considered to be heart disease in the regulatory sense but is considered under the “general medical condition” section of Part 67. The diagnosis still requires a special issuance medical authorization for operations that require a medical certificate. However, for operations under BasicMed, Afib that is well controlled and followed by your treating physician does not require prior special issuance consideration by the FAA.

I may well be missing something however.

 

[lr172]

Not sure that's true in the US if you're already on BasicMed, per AOPA:

Under BasicMed, there are four heart conditions that require a one-time special issuance before you can operate under the BasicMed regulations: coronary heart disease that has required treatment, as noted above; a myocardial infarction (heart attack); heart valve replacement; and heart replacement (transplant).

This was my understanding as well. Unless the event/condition is specifically called out as one of the triggering events outlined, such as the four heart conditions above, no medical condition or event requires an SI. Further, only a one time SI is required in those specifically called out conditions when they occur. There is no requirement to then obtain a 3rd class.

I have studied this carefully, as have been on BM since the beginning. Encourage others to more fully research this topic if applicable. Obviously not applicable to the OP.

The one potential "gotcha" is the somewhat vague / broad category of "coronary heart disease that has required treatment" No definition of what this entails or how a judge would interpret it. That said if the meds prescribed are considered optional by the Dr., I would say it has NOT REQUIRED treatment. It could also be assumed that the use of the modifier "Coronary" makes this limited to issues of the coronary arteries and not the heart itself. Afib doesn't seem to be a coronary issue, at least to this layman. I believe this trigger is focused on the very common issue of blocked coronary arteries that lead to heart attacks, with treatments such as angioplasty, stents, etc. As a layman, I don't fully understand the term Coronary, but doubt most pilots really do.

 

[MacCool]

Not sure that's true in the US if you're already on BasicMed, per AOPA:

Under BasicMed, there are four heart conditions that require a one-time special issuance before you can operate under the BasicMed regulations: coronary heart disease that has required treatment, as noted above; a myocardial infarction (heart attack); heart valve replacement; and heart replacement (transplant).

... Like other arrhythmias, Afib is more of an electrical conduction issue and is not considered to be heart disease in the regulatory sense but is considered under the “general medical condition” section of Part 67. The diagnosis still requires a special issuance medical authorization for operations that require a medical certificate. However, for operations under BasicMed, Afib that is well controlled and followed by your treating physician does not require prior special issuance consideration by the FAA.

I may well be missing something however.

Yeah, if you are already flying under Basic Med and develop a-fib, it looks like a Special Issuance may not be required. It appears you could get cleared/signed off under Basic Med by any physician, but that assumes that a) you can find one willing to do Basic Med, and b) find one willing to do Basic Med and attest that that pilot with new a-fib is safe to fly an airplane. I have done a few Basic Med exams for healthy pilot friends, (with a few qualms), but there is no way I'd sign off on someone with any cardiac condition, including uncomplicated a-fib. I would not want to accept the liability risk. Juice ≠ squeeze.

 

[Dugaru]

I have done a few Basic Med exams for healthy pilot friends, (with a few qualms), but there is no way I'd sign off on someone with any cardiac condition, including uncomplicated a-fib. I would not want to accept the liability risk. Juice ≠ squeeze.

Understandable. I suspect the liability picture isn’t actually worse than with, say, commercial drivers’ medical exams, but who knows.

I do know I’d rather work through an afib issue with my doc for purposes of BasicMed than go through the FAA special issuance procedure. The latter can be Kafka-esque.

 

[riobison]

First, big breath. You will get through this.
Second. A-fib is incredibly common. Surely, someone at Transport Canada has helped someone with this. Ask around. Call another CAME. If TC is asking "you" what the next step is, you need to talk to someone else.
Third. You have likely had this for a while, after being seen by 2 cardiologist and the battery of tests performed. If you're on Apixiban, you must have some risk factors (Chads-VASC), otherwise you would be on Aspirin. The work up has been completed and should make for a quicker resolution.
Lastly. FAA on our southern side of the street has a clear path. I'm not familiar with the northern side, so reaching out like you have just done is a great step. Search on different forums and reddit. Don't give up and don't be shy. This is why pilots don't tell the whole truth on pilot exams. It's frustrating on both sides (pilot and physician examiners).
Source: ED Physician for 20 years, soon to be AME for this reason.

 

[MacCool]

Understandable. I suspect the liability picture isn’t actually worse than with, say, commercial drivers’ medical exams, but who knows.

I do know I’d rather work through an afib issue with my doc for purposes of BasicMed than go through the FAA special issuance procedure. The latter can be Kafka-esque.

I agree… And that’s the whole point of basic med. Staying outside of the bureaucratic morass that the FAA medical branch has created.

as to liability… I think there is a notable perceived difference between liability in a commercial truck crash versus an airplane crash. However, i’ve never done CDL exams and only a few basic med exams, so I base my opinion only on perception and impressions rather than real world experience.

 

[Sportquattro]

I had this a few years ago after the Covid 19 JAB, had to spend about £5,000 doing umpteen Stress Echocardiograms, 24 hour ECG's etc etc and after 6 months on Apixaban and Bisoprolol I got my Class 2 back.

The UK CAA were less than helpful but my AME was a diamond and we got there in the end, last ECG was fine and due another in January.

I know 4 other pilots that all had AFIB after the Covid jab so pretty convinced that was the root cause. (Cardiologist didn't disagree)

Hope you get back in the air

Nige

 

[riobison]

Gents, thanks for the help so far.

I've been calling around and working with the cardiologists trying to find a solution for these guys. Its difficult to play the game when you don't know the rules. And when I'm told what wont work and not even a hint on what they exactly want to make it work does complicate this. With controlled BP at 125//75 is my one risk factor and my age is why I'm on the apixaban. Stress test they wanted a MET 8.5 and 135 bpm. I gave then a Met 16.4 and 155 bpm and held that for 5 mins. I religiously run up to 165 bpm when cross country skiing in the mountains at 8500 ft and maintain this HR for 10 plus mins at a time and have presented this data as well. I may have a minor electrical issue but structurally there isn't an issue with my heart. And this has never ever brought on the AFIB. Looking back now I do believe I've had this for several yrs as that little heart symbol on the BP Cuff would occasionally show up. Now I understand why. The cardiologist asked about CPAP and I've been on that for 15 yrs. TC just found about that and its BAD Ju Ju. I was able to pull those records to show that my physician and I have treated this on our own and I'm still here. Yes, as Ive been finding out AFIB is very common especially as we age and most of us diagnose it on our own with our smart watches. Its good to hear that astronauts are back flying after Cardio ablation. Im on a 2 yr waiting list as my situation isn't life threatening. I had applied for our equivalent of Basic Med or Cat 4 during covid. But with everything shut down it didnt show up in the mail. So, to be legal I went in to renew my cat 3 and I was denied that due to hearing aids and cockpit comprehension not being tested by TC, Turp and my treatment after, border line hypertension in their office. At home with the 24 hr monitor Im normal. Of course my Cat 4 or basic med showed up a week later in the mail and was cancelled shortly there after. Im now on their radar and this is the result for the rest of my flying days. 98% of my flights Im alone, 99% of my flights are over unpopulated areas of Canada. So who am I a risk to? Yet I can load up my mini van and drive down the Hi way at 75 mph with my grand children next to you and your family's. Where am I really the greatest risk if Im a risk?

Yes, all of my ECGs are normal when I go in. Its only abnormal when I'm in AFIB and of course I'm never in there when I'm in AFIB to be tested since this all started.

Hmm, the COVID jab. Good point. I hadn't thought of that one.

There is a pilot in my area dealing with a similar issue. Lost his medical but still drives commercial truck and can still haul a tanker full of fuel around town

I will keep everyone in the loop when I get through this. Any suggestions or ideas, please keep them coming.

thanks

 

[Dugaru]

Its good to hear that astronauts are back flying after Cardio ablation. Im on a 2 yr waiting list as my situation isn't life threatening.

Have you considered medical tourism? Not even kidding. You can get ablation done at very respectable places in Mexico, etc. for high-four to low-five digit $ figures.

 

[LeoKenner]

My partner found out she was in afib when she was getting prepped for a hip replacement. Needless to say, she got a trip to the cardiac ward that day, instead of a new hip. She now has it managed, although I think she is on all the afib meds.... and they since rescheduled and replaced the hip.
They also have her scheduled with a heart rhythm specialist to see about ablation.
Slower than a trip to Mexico, but 100% covered depending on what the heart rhythm specialist diagnoses.

She is not a pilot, so I can't offer much insight into how that works with TC. But its perhaps a little helpful insight in the Canadian medical side of things.

 

[scarlson]

Have you considered medical tourism? Not even kidding. You can get ablation done at very respectable places in Mexico, etc. for high-four to low-five digit $ figures.

I will add my recommendation to head south of your border and get an ablation. I live in Washington and many Canadians travel here for elective procedures that are backlogged at home. That will probably get you back in the air quicker than any other route if that's your priority. (I don't know the inner workings of TC). Just a couple words of caution: just because AF is fairly common and sometimes asymptomatic, that doesn't mean yours will be, especially as you get older; not every ablation is a permanent fix; your aerobic conditioning is commendable but not necessarily relevant to your heart's electrical system. I hope you're flying soon.

 

[Canadian_JOY]

Medical tourism may sound crazy, but it absolutely is not crazy. The Canadian "treatment by triage" method means low-risk patients (AFIB generally is pretty low on the cardiac risk spectrum) get pushed to the back of the line. Getting ablation done outside the country is very much worth considering, especially if your AFIB is recurring.

Also note that apixaban is pretty much considered mandatory in AFIB patients over the age of 65. It's treated like a binary switch - irrespective of other risk factors or health indicators.

If considering medical tourism, please don't discount the recovery time needed following ablation. It's quite amazing to see some ablation patients back to normal in short order and some still feeling somewhat lower-energy after a couple of months.

 

[RV8JD]

I will add my recommendation to head south of your border and get an ablation. I live in Washington and many Canadians travel here for elective procedures that are backlogged at home.

No wonder it takes so long to find a Doctor and get a medical appointment here!

 

[Steve Crewdog]

This company is under contract by the Airline Pilots Association and part of our dues pay for their services. A pilot I know who just retired had their first full non-aeromedical physical done in a long time, the new doc raised all kinds of red flags about something that was potentially grounding in their bloodwork and wanted them to go through a battery of tests, which freaked them out (If you go looking for a problem, you're going to find something wrong, even if it's not related to the original problem.). Anyway, it turns out that even non-airline pilots can use them for a nominal fee, and from problems they helped me out with when I was active I can vouch for them 100%.

My buddy called them Monday morning (it was a LONG weekend for them) and after a $70 consultation sent them their blood work. They called back in 30 minutes and said the new Doc must be behind on their alimony, the problem was nothing. New Doc didn't like being overridden, but it's my buddy's call.

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AOPA also has some kind of benefit like this for its members but I've never used it and not sure how good it is or who it's by.

 

[Thermos]

.... and from problems they helped me out with when I was active I can vouch for them 100%.

+1 on AMAS. They've helped me more than once with medical cert issues, and the ability to get a phone consult for a few (by aviation standards) $ has saved me a lot of angst when I was concerned about an upcoming flight physical.

ds

 

[Dugaru]

I know 4 other pilots that all had AFIB after the Covid jab so pretty convinced that was the root cause. (Cardiologist didn't disagree)

What’s actually known to cause afib is…. Covid.

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research - PMC

COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular ...

pmc.ncbi.nlm.nih.gov

 

[lr172]

; not every ablation is a permanent fix; your aerobic conditioning is commendable but not necessarily relevant to your heart's electrical system. I hope you're flying soon.

my mother suffered with afib that was ultimately found after it caused a mini stroke; luckily it happened while in the hospital so far less severe than most. I get the sense the ablation is not often one and done. They find what they think the issue is and zap it. On follow ups they typically find others that need to be zapped that didn’t become apparent until the first problem area was now gone. My mother had two or three rounds, but then it was gone permanently.

 

[lr172]

What’s actually known to cause afib is…. Covid.

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research - PMC

COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular ...

pmc.ncbi.nlm.nih.gov

Unknown if or how covid can trigger afib, but that is NOT its primary cause. Will let the Drs here explain details.

 

[Ironflight]

Hey guys….any mention of COVID seems to eventually end up in politics, so let’s not go there - the cause of the OP’s A-Fib is not his question.

 

[scorwin]

Infection (most any kind) can cause an inflammatory reaction -> a-fib. That's not the OP. OSA (sleep apnea), thyroid, alcohol are common causes. OP had the workup above. OP does use a CPAP (OSA), so likely a stretch if it's treated appropriately. What's left is most likely, reentrant tachycardia. Think of it as an electrical bypass. Ablation cuts the bypass. Sometimes, there's another one that needs to be cut. Or another. The cases can take several hours to map it out and perform the ablation.
The OP is asymptomatic. Found it on his watch. I'd be hard pressed to suggest or recommend an ablation to someone that is asymptomatic.
AMAS and AOPA are FAA based. Not much help to the OP. COPA is an interesting thought though. A phone call wouldn't hurt to them.

Stress tests and ability to exercise is related to ischemic heart disease. This is not that. That's more of a plumbing situation. This is electrical.
Calling more cardiologist will not help. You need help from inside. It's already mentioned. Find out what they want and provide that. Call COPA.

I applaud you for trying to do this legally. That can't go unmentioned. You obviously want to do the right thing, just need some help. Keep poking around, someone can help, specifically for Canadian pilots.

 

[rv699jb]

I had a student pilot that developed A-Fib. It was transient, like yours. Meds didn’t work. He went to another Doc for a second opinion and the Doc told him to try something that he said would be very hard. The cure was to 100% get off all caffeine and nicotine! No coffee, soda pop, or smoking or chewing. He also said to set out twelve cups of water and drink all of them during the day, even if not thirsty, to stay well hydrated. The second day of this treatment, his A-Fib disappeared! He was in disbelief a couple weeks later and had a couple cups of coffee. The A-Fib reappeared! He got back on the treatment and hasn’t had another episode in two years now. Not sure if this fits your diet profile, but if it does it might be worth a try, although coffee and cigarettes are a hard habit to break.
Jim Baker
RV-6

 

[riobison]

Have you considered medical tourism? Not even kidding. You can get ablation done at very respectable places in Mexico, etc. for high-four to low-five digit $ figures.

I've thought of it. Now my spanish is pretty good after living and working in Peru and Colombia for over 10 yrs. First I have to google a search for cardiac electrophysiologist and go off of google reviews. This above my comfort factor and I do realize they have some really good doctors that have trained north of the border. Then there is the exchange on the cdn peso. This can be really expensive especially if it doesn't work the first time or if there are complications.

 

[riobison]

My partner found out she was in afib when she was getting prepped for a hip replacement. Needless to say, she got a trip to the cardiac ward that day, instead of a new hip. She now has it managed, although I think she is on all the afib meds.... and they since rescheduled and replaced the hip.
They also have her scheduled with a heart rhythm specialist to see about ablation.
Slower than a trip to Mexico, but 100% covered depending on what the heart rhythm specialist diagnoses.

She is not a pilot, so I can't offer much insight into how that works with TC. But its perhaps a little helpful insight in the Canadian medical side of things.

In Canada once your in, the system works and there is no question about that. Its getting your foot in the door that's frustrating.

 

[riobison]

This company is under contract by the Airline Pilots Association and part of our dues pay for their services. A pilot I know who just retired had their first full non-aeromedical physical done in a long time, the new doc raised all kinds of red flags about something that was potentially grounding in their bloodwork and wanted them to go through a battery of tests, which freaked them out (If you go looking for a problem, you're going to find something wrong, even if it's not related to the original problem.). Anyway, it turns out that even non-airline pilots can use them for a nominal fee, and from problems they helped me out with when I was active I can vouch for them 100%.

My buddy called them Monday morning (it was a LONG weekend for them) and after a $70 consultation sent them their blood work. They called back in 30 minutes and said the new Doc must be behind on their alimony, the problem was nothing. New Doc didn't like being overridden, but it's my buddy's call.





AOPA also has some kind of benefit like this for its members but I've never used it and not sure how good it is or who it's by.

thanks. worth a call