Taking Flight with Atrial Fibrillation: A Guide to the AME Assisted Special Issuance (AASI) Process"

Introduction:

As a pilot diagnosed with atrial fibrillation, it's crucial to understand the process of obtaining an airman medical certificate under the AME Assisted Special Issuance (AASI) program. Atrial fibrillation is a disqualifying medical condition under FAA regulations, but with the proper steps and documentation, you may be eligible to fly again. This article aims to guide pilots with atrial fibrillation through the AASI process, ensuring aviation safety while accommodating individual health needs.

What is the AASI Process?

The AASI process allows pilots with atrial fibrillation to re-apply for an airman medical certificate. By obtaining an Authorization for Special Issuance of a Medical Certificate from the FAA, you can demonstrate that you meet specific medical standards and can safely operate an aircraft.

Required Documentation:

To apply for an AASI, you will need to submit the following documentation to your Aviation Medical Examiner (AME):

a. An FAA-granted Authorization.

b. A report of a 24-hour cardiac monitor test performed within the last 90 days, even if the results are normal. Include a 1-page computerized summary and representative full-scale multi-lead ECG tracings.

c. Complete the FAA Atrial Fibrillation (AFib)/A-Flutter Recertification Status Report or provide a cardiologist evaluation addressing all items on the report.

d. Provide data verifying that you have not experienced a stroke, transient ischemic attack (TIA), or other thromboembolic events.

e. Ensure your heart rate is well controlled based on a cardiologist's interpretation.

f. If necessary, explain how you manage symptoms, heart rate, or rhythm control.

g. Verify that emboli mitigation is in place without side effects when your CHA2DS2-VASc score is ≥ 2. Acceptable emboli mitigation may involve using anti-coagulation medications like NOAC/DOAC/warfarin.

Deferment to AMCD or Region:

In some cases, your AME may need to defer your application to the Aerospace Medical Certification Division (AMCD) or the FAA Region for further review. This is necessary if:

1. a. You have undergone left atrial appendage (LAA) occlusion (Watchman)/excision or developed a new cardiac condition.
2. b. There have been definitive or suspicious thromboembolic events during the interval.
3. c. Your cardiology interpretation shows questionable or poor rate control (average heart rate > 100, maximum non-exercise heart rate > 120, or a single pause > 3 seconds).
4. d. You do not have adequate management of symptoms, heart rate, or rhythm.
5. e. Your CHA2DS2-VASc score is ≥ 2 without proper emboli mitigation.
6. f. You experienced interval bleeding that required medical intervention.

Conclusion:

Flying with atrial fibrillation is possible through the AME Assisted Special Issuance (AASI) process. By following these guidelines and providing the necessary documentation, you increase your chances of obtaining an airman medical certificate. Remember, aviation safety is paramount, and the AASI process ensures that pilots with atrial fibrillation can fly safely while taking individual health needs into account. Consult your AME for further guidance and support throughout the AASI application process. Safe skies and happy flying!