Taken from the JAA manual of civil aviation medicine (feb 2005)
Initial Issue MANUAL 2 - CARDIOVASCULAR SYSTEM - 24
JAA Manual of Civil Aviation Medicine
01.02.05
b Right bundle b ranch block
Incomplete right bundle branch block is seen in 2–3% of routine flight crew
electrocardiograms and appears to carry a normal prognosis in asymptomatic subjects. No
special requirements are needed.
Complete right bundle branch block has a prevalence of about 0·2% in flight crew. When
isolated, established and unassociated with other abnormality of the myocardium or
coronary circulation, there appears to be no significant risk of development of further
degrees of block or of syncope. Recently acquired right bundle branch block usually also
has a benign prognosis provided significant coronary artery disease is not present.
On first presentation of complete right bundle branch block certification to fly may be
considered, provided that:
i A symptom-limited exercise ECG to Bruce stage IV, or equivalent, shows no significant
abnormality or evidence of myocardial ischaemia. Cardioactive medication (i.e beta -
blocking agents/vasodilators) ideally will have been withdrawn 48 hours beforehand.
Scintigraphy/stress echocardiography may be helpful for future reference and/or in the
presence of an abnormality in the resting ECG;
ii echocardiography/radionuclide/contrast ventriculography demonstrates a left
ventricular ejection fraction ? 0·50 without significant abnormality of wall motion such
as dyskinesia, hypokinesia or akinesia;
iii coronary angiography is carried out should there be any doubt about the result of non -
invasive investigations (see paragraph 4 above);
iv the co-existent presence of first degree heart block and anterior or posterior hemiblock
is evaluated by an electrophysiological study.
v a 24-hour ambulatory ECG demonstrates no significant rhythm disturbance or higher
degree of conduction disturbance;
vi follow-up by a cardiologist acceptable to the AMS with exercise ECG/scintigraphy, 2D
Doppler echocardiography and 24-hour ambulatory ECG is carried out as appropriate;
vii recertification is restricted to multi -pilot operation (Class 1 ‘OML’) for at least one year
when stable. Established complete right bundle branch block may be considered for
unrestricted Class 1 subject to satisfactory completion of the above.
This level of assessment also applies to Class 2 and Class 2 ‘OSL’.