Page 380 - UK AirCrew Regulations (Consolidated) March 2022

Part MED - ANNEX IV - Medical

(7) Complete left bundle branch block
Applicants with complete left bundle branch block may be assessed as fit with
appropriate limitations, such as an ORL, and subject to satisfactory cardiological
evaluation.
(8) Ventricular pre-excitation
Asymptomatic applicants with ventricular preexcitation may be assessed as fit with
limitation(s) as appropriate, subject to satisfactory cardiological evaluation.
Limitations may not be necessary if an electrophysiological study is conducted and
the results are satisfactory.
(9) Pacemaker
Applicants with a subendocardial pacemaker should be assessed as unfit. A fit
assessment may be considered no sooner than 3 months after insertion, providing:
(i) there is no other disqualifying condition;
(ii) a bipolar lead system, programmed in bipolar mode without automatic mode
change, has been used;
(iii) the applicant is not pacemaker dependent; and
(iv) the applicant has a follow-up at least every 12 months, including a pacemaker
check.
(10) QT prolongation
Applicants with asymptomatic QT prolongation may be assessed as fit with an ORL
or OSL subject to satisfactory cardiological evaluation.
(11) Brugada pattern on electrocardiography
Applicants with a Brugada pattern Type 1 should be assessed as unfit. Applicants
with Type 2 or Type 3 may be assessed as fit, with limitation(s) as appropriate,
subject to satisfactory cardiological evaluation.
(m) Heart or heart/lung transplantation
(1) Applicants who have undergone heart or heart/lung transplantation may be
(1) Applicants who have undergone heart or heart/lung transplantation may be
assessed as fit, with appropriate limitation(s) such as an ORL , no sooner than 12
months after transplantation, provided that cardiological evaluation is satisfactory
with:
(i) no rejection in the first year following transplantation;
(ii) no significant arrhythmias;
(iii) a left ventricular ejection fraction ≥ 50%;
(iv) a symptom limited exercise ECG; and
(v) a coronary angiogram if indicated;
(2) Regular cardiological evaluations should be carried out.
MED.B.010 GM1 Cardiovascular system
MITRAL VALVE DISEASE
(a) Minor regurgitation should have evidence of no thickened leaflets or flail chordae and left
atrial internal diameter of less than or equal to 4.0 cm.
(b) The following may indicate severe regurgitation:
(1) LV internal diameter (diastole) > 6.0 cm; or
(2) LV internal diameter (systole) > 4.1 cm; or
(3) Left atrial internal diameter > 4.5 cm.
(c) Doppler indices, such as width of jet, backwards extension and whether there is flow
reversal in the pulmonary veins may be helpful in assessing severity of regurgitation.
MED.B.010 GM2 Cardiovascular system
VENTRICULAR PRE-EXCITATION
Asymptomatic applicants with pre-excitation may be assessed as fit if they meet the following criteria,
which may also indicate a satisfactory electrophysiological evaluation:
(a) refractory period > 300 ms;
(b) no induced atrial fibrillation.
MED.B.010 GM3 Cardiovascular system
ANTICOAGULATION
Applicants taking anticoagulant medication which requires monitoring with INR testing, should
measure their INR on a ‘near patient’ testing system within 12 hours prior to flight and the privileges of
the applicable licence(s) should only be exercised if the INR is within the target range. The INR result
should be recorded and the results should be reviewed at each aero-medical assessment.
MED.B.010 GM4 Cardiovascular system
MITRAL VALVE DISEASE
(a) Minor regurgitation should have evidence of no thickened leaflets or flail chordae and left
atrial internal diameter of less than or equal to 4.0 cm.
(b) The following may indicate severe regurgitation:
(1) LV internal diameter (diastole) > 6.0 cm; or
(2) LV internal diameter (systole) > 4.1 cm; or
(3) Left atrial internal diameter > 4.5 cm.
(c) Doppler indices, such as width of jet, backwards extension and whether there is flow
reversal in the pulmonary veins may be helpful in assessing severity of regurgitation.
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