Advice on extrasystoles

[Soft Parade]

Hi everyone,

I am planning to have my initial class one medical next March in Spain. Given that a recent Holter showed the number of extrasystoles to be rather high, I have underwent radio frequency ablation last month in order to reduce their number.

While waiting for the "results" of the intervention (I am wearing Holter at the moment) I was wondering if anyone knows if there is any limiting number of extrasystoles that would disqualify one from obtaining the class 1. I am asking this because my cardiologist (who is not an AME) might find this information useful so as to know whether the RF ablation should be repeated. Alternatively, she mentioned the possibility of taking beta blockers, and I wanted to know if a holder of class 1 could take such a medication in Europe (I have read that FAA allows for it, though).

Thanks in advance!

[Radgirl]

There are many reasons for extra beats, many of which are benign and irrelevant.

However it is clear you have had a major intervention and are under a cardiologist so the issue is the underlying pathology. ie the CAUSE. We would need to know what the problem is to determine the prognosis and the likely response of the regulator.

You would be best advised to get a complete medical report from your cardiologist AFTER he has completed all his tests and submit it to an AME for advice. Many abherrant pathways that conduct electricity the wrong way in the heart are irrelevant after they have been destroyed or ablated, so I wouldnt be too worried, BUT you have not provided enough information for anyone to give a sensible reply

Except perhaps Winnhofer...

[Soft Parade]

Thanks for your reply, I will do as you suggest.

The cause appears to be Epstein-Barr virus I had 4 years back. Apart from this, and from the fact that doctors managed to reduce the number of extrasystoles although not eliminate them, I don't know much. The cardiologist did say my heart is "healthy and strong" and that there shouldn't be any problem, but given that she is not an AME, I was worried she might be giving too optimistic assessment. Thanks again.

[cavortingcheetah]

BUT you have not provided enough information for anyone to give a sensible reply

Except perhaps Winnhofer...

...and that reminds me.....Massachusetts General Hospital still carries out ablative psychosurgical procedures

[hunterboy]

In answer to the earlier Q, you can take Beta blockers and hold an EASA Class one medical. The licensing body of the relevant authority should list the medication on their website.

[Radgirl]

SP

EBV and other viral infections can produce arrythmias but I am struggling to see how it could be treated by ablation. Like so often in medicine information gets jumbled as it passes from person to person, so get a proper report. If you wish PM me with it and I will give you a one liner opinion, although my Catalan is a little rusty!! indeed non existent!!!

[flymo253]

Hi all!

... what a coincidence! I have recently been in a german AMC to get my initial class 1 medical (EASA). During the ECG, I too had some extrasystoles. So they conducted a stress ECG which was fine - under stress, I had no extrasystoles anymore. However, the chief physician was still not fully satisfied. So he sent me to a cardiologist next door. He did another resting-ECG and an echogram which both showed that I definitely have a healthy heart. Still, this wasn't enough for the doc to issue the medical. I had to do another 24 hour ECG which showed some extrasystoles which isn't a cause for concern at all since my heart is perfectly healthy. A few days ago, the doc from the AMC called me saying that I will need to go to an electrophysiologist. Though, he said that it "definitely does not make me unfit to fly".

Seems that we both are in the same boat! ;) I have been told that too much caffeine as well as (emotional) stress *could* be a cause of extrasystoles. And I drunk about 2 - 3 litres of green tea a day:}:confused:

I keep my fingers crossed for you! Keep us updated!

Best regards

[Radgirl]

On the face of your posting - and we all know that 'patients' can be misled by partial information - this is at best German pedantic medicine

You are allowed single 'safe' ectopics or extrasystoles - the number varies country to country but lets say 2-5 a minute. If you have no other symptoms we normally ignore them. Not sure what the purpose of an exercise ECG is but there you go. However, if they have said it definitely wont stop you getting your medical AFTER you have seen a cardiologist either they are allowing some medically dodgy pilots to fly in your country or they are testing people who they believe are healthy.

I suggest the latter. The problem with doing lots of tests in medicine is that either you get a false result, or a false positive, and then you are on the slippery slope of having treatment. All treatment has both risk and benefit. Then the risk happens.

If it definitely wont stop you flying, I wonder what would happen if you refused the additional tests........

So be very careful about not only 'just another little test' but also any recommendation for treatment. And as always please let us know how you get on as we learn from this feedback

[flymo253]

Hi Radgirl!

Thanks for your answer! The AMC I went to is known to be quite strict.. I lately talked to a pilot who also suffers extrasystoles - for him it has never been a problem. He recommends not to drink any kind of caffeine at least three days prior to an ECG.. Wonder if this could be a cause?!:confused:
In my first ECG (which lasted about a minute I guess), I had 3 (or 4?) extrasystoles. As you said, I do not have any other symptoms and I am in perfect health. Moreover, the 24h holter revealed that I had "some monomorphic extrasystoles" meaning that all extrasystoles have the same origin and form (which is, as my family doctor told me, good). Next tuesday, I have an appointment with an electrophysiologist. I am curious what he will do..

Btw... Are you an AME? :)

[Radgirl]

So on the face of it you fall within the definition of 'normal' and yes a lot of caffeine will cause this problem.

I wonder if you can bypass your AME and discuss it with your regulator.....

An electophysiologist will look for abnormal electrical pathways in the heart that we dont think you have!!! It is possible he or she will look at your results and say 'rubbish'. At the other end of the spectrum they pass wires from a blood vessel in your groin into the heart to measure the passage of electricity in different parts of the heart and identify the problem.

Now this is very common and if needed no big issue - takes an hour or so and home you go. However, there is a small risk of damage to the blood vessel and issues within the heart. If they do recommend this - and they wouldnt do it the same day - I really think you need another AME or to get confirmation of need from your regulator

No I am not an AME, just a doctor and pilot.

[flymo253]

A little update: I saw another doctor today (rhythmology) who conducted an ECG. Guess what... the ECG was perfectly normal. No extrasystoles, no nothing. The doctor also had a look at the report of the 24 hour ECG. During the 24 hour ECG I had about 15% extrasystoles:ooh:. BUT.. since I have a healthy heart without other symptons or complaints such as dyspnoea, dizziness etc. it is nothing to worry about. Further more there is no reason to treat them, he said. So why did I have so many extrasystoles during my 24 hour ECG and none during my ECG today? As I already mentioned, I used to consume about two to three litres of green tea a day (which cotains lots of caffeine and theine). I haven't been drinking ANY kind of caffeine now for the last two weeks. According to the doc, it is very likely that this absurd quantity of green tea caused my extrasystoles. He recommended to do another 24 hour ECG to see whether this is the case.

I will call my AME tomorrow and tell him about this. Let's wait for his reaction.. I also wonder if 15% of extrasystoles makes me "fit to fly" (though with OML)?

Thank you Radgirl for your help! :)

[HEATHROW DIRECTOR]

...and, if I may say, an extremely useful member of this forum

[Radgirl]

Flymo 253

Good news - this guy is saying you are fine - fit - so fingers crossed the others will fall in line. I see no reason for any endorsement as we are saying you were normal with extrasystoles and now you are normal without any!!!

Thanks HD - making me blush

[AngioJet]

Good decision on the green tea, I reckon the quantities you used to consume would be enough to give anyone palpitations! ;)
Best of luck with your new 24h ECG!

[flymo253]

I just called my AME and he too said that this huge amount of green tea could be the cause for my extrasystoles - or at least made them worse. He wants me to do another 24 hour ECG. So be it - I will do another one next week. By the way: sleeping with this halter is a nightmare!!!:uhoh:

Thanks for your help all, I will of course keep you updated!

@SoftParade: have you heard something new? :)

[Soft Parade]

@flymo 253: my cardiologist suggested taking beta blockers for a month or so before scheduling another Holter and seeing how the results will improve.

I'll keep you all informed and thanks for all your help.

[Radgirl]

I dont think this is a good idea. First, you cant fly for at least two weeks, and I suspect your AME or regulator would want further information on your heart rate and blood pressure even then. You wouldnt know if you still had extra beats suppressed by the drug or whether it had gone away. and so I fear the regulator is going to consider you a long term 'problem' Far better to see if this was a temporary phenomenon, and even if you still have a problem consider whether it needs any treatment.

[flymo253]

Hi all!

I had an appointment with my family doctor today. Next week I will do another 24 hour ECG. Moreover, he recommended to take a magnesium / potassium supplement since this will help to reduce heart arrhythmia (also extrasystoles). I have found a supplement in my local pharmacy where one pill (recommended daily dose) contains 400 mg magnesium, 300 mg potassium, 5 mg zinc and 3,5 mg iron.

What you think? Is it a good idea to take those?

Best regards! :)

[gingernut]

I'd start with the symptoms that you are experiencing, then work back.

Oh hang on, have you got any symptoms.

Perhaps you need to look at how your results put you at risk of sudden incapacitated.......oh hang on.

As Radgirl has alluded, try your best not to medicalise things :-)

[Radgirl]

Flymo253

I suspect your GP is just trying to help.

Low potassium produces massive arrythmias and after heart operations on ITU we used to give gallons. We now give litres :ok:. However, unless you are on some strange diet or take diuretic drugs (or have just been on cardiopulmonary bypass for an open heart operation!!!), it wont be low. If you are worried eat a couple of banana a day - that is just as good. Incidentally, and off on a tangent, because K40 is radioactive, all bananas are radioactive!! So we could measure the exposure of pilots to solar radiation on a transatlantic flight in bananas :D

Magnesium is the new potassium and the in drug on ITU. Everyone on ITU has it measured and topped up. IMHO it is a silly fad and totally without population evidence. Again, you have to be on a mad diet for it to be low if you are young and fit.

Keep at it - it seems everyone is convinced you are healthy on this thread!!!

[cavortingcheetah]

If you want to raise your potassium levels try eating bananas drizzled with Marmite.

[gingernut]

Electrolytes have an important role.

Visit a greengrocer and you won't go far wrong.

Getting back to the "extra beat" thread, I suspect RADGIRL is spot on :-)

[flymo253]

Thanks all for your kind help! I do really appreciate it! :)

The cause for my extrasystoles? My doc said that it could be the green tea, stress etc. But it is definitely nothing organic.

Seems that everyone here (including the several doctors I have been to), is convinced that I am healthy. Except my AME. He says it does not make me "unfit to fly" but still not wants to issue the medical class 1..:ugh:

Let's wait what the next 24h holter reveals..

[Thomas coupling]

I remember my AME picking up on extra beats. Eventually I had to wear a 24hr holter monitor. They fit it in the hospital and seal the unit to stop you tampering.
On the way home, I got caught up in traffic and the delay made me hungry so I pulled into a McD and ordered this and that AND a coke.
Ooooh la la - my heart went beserk with ectopics - absolutely beserk.
Realising this would do me no good in the review, I got home opened the holter and erased all the recording!
I rang the hospital up and told them it didnt seem to be working - so they gave me another one......and I stayed well clear of coke!
I passed the 2nd test!

[flymo253]

@Thomas: not bad!:D Do you think it is related to the caffeine in coke? Nice to hear that you passed the second test!

I still have no new news about my latest 24h holter. My AME/AMC will receive the results of the 24h holter tomorrow. I neither know whether my extrasystoles (16% in fact) during the first holter were only related to green tea nor if they have deminished during the last holter. Guess I will have an answer next week..

Does anyone know if, according to EASA requirements, a specific number of extrasystoles makes one "unfit to fly"? Flying is my love, my life, my everything. I don't want to lose it.. :(

[Thomas coupling]

Flymo, when I was tested, the CAA maximum was 13%.
Over that they ground you. It may have changed since 2007.

[flymo253]

I just found the newest EASA requirements on my regulator's website. According to EASA, there is no limiting number of extrasystoles you can have. However they must be monomorphic (that means that they all have the same form/origin) and you are not allowed to have any other symptoms. AND you must have perfomed a positive stress ECG + echo (which I did). Let's wait and see..

[Soft Parade]

@ Thomas_coupling: Hi, where have you done your medical? When i opened this thread one month ago, i didn't have the information you mentioned about the 13% limit and i'm pretty happy about it as I have 10.5% of extrasystoles...

@ flymo253: Can you please pass me the link you're referring to? As in your case, my extrasystoles are monomorphic and echo is "good even for pilots", as the cardiologist said. Also, whenever there are more than 100 beats per minute, extrasystoles completely disappear. The cardiologist (not an AME, I haven't done my initial yet) concluded that the heart is "healthy and strong" and that there shouldn't be any problems.

However, on this very thread, you can find the information that anyone who has more than 5 extrasystoles per minute would be grounded. But then, the two criteria are incompatible: I have an average of 8 extrasystoles per minute but at the same time I have less than 13% of extrasystoles. Which of the two criteria is more important? Not to mention this new piece of information flymo253 provided, according to which there isn't the limit of extrasystoles to begin with...

Thanks!

[flymo253]

@SoftParade: I have sent you a PM! I am in the same situation as you! During my exercise ECG I didn't have any extrasystoles. My doc said that this is a good sign since heart problems would show up at latest during an exercise ECG. My echo was perfectly normal as well. After my first ECG holter in which I had 16% of extrasystoles (hopefully it was just the huge amount of green tea!), my AME said that this "does definitively not make me unfit to fly". Though, he wants some more investigations.


Guess I won't hear anything new from my AME before next year.. However, I will call my GP tomorrow so he can provide me with the results of the second fu***** holter! ;)

By the way: radgirl said that, in case you have more than five extrasystoles during a "normal" ECG, further investigations might be deemed necessary. Radgirl didn't say that it grounds you. (Or did I misunderstood you, Radgirl?)

[flymo253]

Hello all!

I am in a very unpleasent situation right now. I went for my initial class 1 medical (EASA / germany) back in October last year. On the ECG, I had some extrasystoles. I conducted an exercise ECG as well as an echo. Both showed a structally normal, healthy and strong heart. No indications at all. Then I had to do two 24 hour ECGs which showed monophorbic ventricular extrasystoles. During the first holter, I had about 15% and on the second holter it was much less already. According to EASA, I have done everything to get a medical class 1. Even the cardiologist said that I am fine. But my AME won't believe it. He refuses to issue me the medical. He wants to send me to an electrophysiologist assuming that there might be something wrong with any ventricle (actually without any indication that there *might* be something wrong).

Long story short, a friend of mine (a captain) brought up the idea to approach the licensing authority (in my case the LBA) directly or consult another AME.

What do you think? Is there anything I can do or shall I obey my AME's instructions?

Any help is highly appreciated!

Best regards
flymo253

[space-shuttle-driver]

flymo, you got a PM.