Bundle Branch Block and Class 1!!!

[Paultuk]

Hi all,

I hope someone could give me a bit of help / guidance.

A few years ago i went to my local AME and got poked and podded and left his practice with a Class 2. All went ok during the examination until the ECG. He said hmmm and moved sensors etc and went hmmm again and said i might have LBBB or RBBB (I can't recall which one he said at the time) but i remember him saying you definitely wont fly commercial. At that moment i was a it worried but he said if you had it at birth (how the hell would i know??) then don't worry about it and carry on with life etc.

I passed my PPL last year and have seriously been thinking about trying for my Class 1 Initial at Gatwick and carrying on to get my CPL (Medical permitting obviously). I have been reading up on both left and right conditions on the net etc and i really do wish i could find out exactly what i have and if it affects my possible career chances in airtravel.

Sorry to babble on but what i really want to know is:

1. When i goto Gatwick do i tell them straight away i might possibly have LBBB or RBBB?

2. Is there anyone out there with a Class 1 and LBBB / RBBB?

3. If so how does it affect your career? Constant medical tests etc??

I would greatly apreciate any feedback on this, and i feel this is the best place to start off!

P.S I excercise regularly, Do not smoke, drink carefully, watch what i eat and have never had any problems with my heart at all. Oh also my original AME has since retired so i cant go back and ask hime what i had!!!

Thanks in advance guys. Safe Landings!!

Paul T - UK

[fernytickles]

Before going to the folks at Gatwick, why not have yourself thoroughly checked over by a specialist? It might save you extra hassle when at Gatwick.

[ITFC1]

Check your messages, i have gone through this a year ago.

[deltahotel]

diagnosed as partial RBBB from birth when did original ECG for RAF in 1976. This has caused no probs for mil or civ. Normal medicals suffice with annual ECG (i'm over 40). i believe that LBBB is a different kettle of salmon. good luck. DH

[ITFC1]

As DH said, i think left is worse than right. I cant remember why.

Mine is a RBBB. I was originally turned down by RAF and CAA some years back, the CAA rules have changed as of November 2005. I couldnt get my Class one as i couldnt be issued with a Initial Class 1 restricted. This has now changed. I was the first one to get a 1st Class inital restricted issued. I do have 2000 Hours now too flying on my FAA CPL/IR, so i dont know if that was taken into account too.

I was told late 2005 to see a specialist the CAA recomended in London and they would go on his say so and i had to have a less than 1% chance of the condition worsening ever year.

So yes you can now fly as of it, i am restricted to As or with Co Pilot.

As i said in my PM call me if you like, i may be able to explain it better.

[geniculate]

Lbbb - Rbbb?

You are right that LBBB is worse that RBBB.

LBBB when it presents almost always indicates that there is something ominous underlying and therefore is treated seriously in anyone that has it.

By contrast, RBBB can be a finding in otherwise normal hearts though there could be a problem that may require investigation. Indeed you could be born with as in DH's case.

Both conditions tend to be asymptomatic, so would probably be an incidental finding on your annual ECG.

Hope that helps a little for background information.

[Paultuk]

Thanks for your replies guys. Quite interesting what you have all been through etc. I think i'll just bite the bullet and book a Class 1 Initial and see what happens?
Its good to see that the CAA have changed their rules on this now.


Thanks again chaps for your help.

Regards
Paul

[aviationascent]

i am just going through all this!!!

today i found out that i may have WPW syndrome, or Wolff Parkinson White syndrome. This was found during a class one medical by my DAME. After having an eccocardiogram and stress test at the cardiologist, i have now been referred to an Electrophysiology Cardiologist who will conduct further tests. I do not suffer from any symptoms and have been saving for the past 3 years for an intergrated CPL with MECIR course that i was to start when i had my medical, to now find out it may have been in vein!

I have been so disheartened all day and now i won't find out for 3 weeks exactly where I stand. On the report from the original cardiologist it says that I have an incomplete RBBB and possible delta wave (V4). what ever that means.

the Electrophysiologist will asess me for whether i would benefit from a day surgery that uses radiofrequencies to eliminate possible conductors in the heart.

my dame says that CASA may not give me my class one medical and that he would be surprised if i would get employment with an airline, even if i had the surgery to normalise the condition IF it is concluded that i infact have the condition.

wondering if there are any airline pilots out there with the condition? i have read the CASA specs on if this occurs to a practising pilot. (it includes suspension from duties until the condition is normalised, then being restricted, with reviews at 6 months, 12 and 24 months then back to normal.) but how does it affect a wannabe?!

the casa documentation reads as follows:
Wolff-Parkinson-White Syndrome
Class 1, 2 and 3 Medical Certificates
On diagnosis of the condition, inform CASA Aviation Medicine Section and advise applicant not to exercise the privileges of his/her licence until investigations have been
completed and results assessed as satisfactory by CASA.

Recertification
Investigations required for recertification are:
*Routine aviation medical examination
*Cardiologist’s assessment
*Electrophysiological studies.

If WPWS is confirmed, the applicant is assessed as unfit until radiofrequency ablation of aberrant conduction pathways has been performed and the treating cardiologist has certified that conduction has been normalised. All applicants may then be recertificated
for six months without restriction.

Subsequent Reviews
At six months, 12 months and 24 months post successful radiofrequency ablation of aberrant conduction pathways, the following are required:
*Routine aviation medical examination
*Cardiologist’s review.
If there is no recurrence of abnormal conduction within 24 months of successful radiofrequency ablation, further recertification without restriction should follow the normal
pattern for the applicant’s age and class of medical certificate.

Questions:
*Is this just going to pose too much of a problem re employment, making investing all this money on training a waste?
*If CASA says i'm fit then will the airlines base my wellbeing on this or conduct independent medical procedures and drag me over the coals about it for my entire career?
*Does anyone have any good news stories for me regarding similar situations?

Cheers all.

[waveydavey]

These may be of some use
LBBB

RBBB

[QDMQDMQDM]

I am a GP, not cardiologist or AME.

If you do turn out to have WPW, the electrophysiologist will probably try to stimulate an arrhythmia. Depending on whether he can and how easy it is, will, I suspect, depend your chances of a Class 1 and any restrictions to be attached to it. The fact that you have never had any symptoms is strongly in your favour.

If you do have an easily stimulatable arrhythmia, which seems a bit unlikely, then radio-ablation of the abnormal conduction pathway may completely cure you.

Don't give up heart at this stage by any means! You may not even have WPW.

[aviationascent]

Thanks for helping me keep perspective!

QDM,

Thanks for your words of wisdom. I must admit however, I feel like a hypocondriac. When I stand up from a rested position and my heart is pumping away to keep the blood in my head, i find my self thinking, is this an arrhythmia? Stupid I know. Everything starts to seem like it could be a symptom!

Anyhow, just wanted to say thanks, you have given me more light at the end of the tunnel! I think this waiting game between specialists is a killer!

Cheers.

[Jarvy]

About 2 years ago I was grounded due to an adnormal ECG. It turns out I had Cardiomyopathy that was resulting in LBBB. Treatment involved rest and drugs. After about a year my heart had returned to its normal size so I applied to the CAA for a review of my status.
After having a 24 hour holter the CAA become worried enough to contact my consultant and I was admitted to hospital with broad complex tachycardia. Then I was transfered to St. Thomas' in London where EP studies (wires into heart via groin) were carried out, some abilation was also done.
In February I had further tests at the CAA and I have now got intermittant LBBB and also now have ectopic heart beats(the odd extra beat) so my case is going to the cardiology comittee at the CAA in June.
I have the backing of 2 consultants, my ame and my GP but the CAA can't make their minds up.
All through this time I have been free from any symtoms.
So don't give up and good luck.
Jarvy
P.S. CPL(H) self funded but have done not a days paid flying as the above
was found just as I had done my OPC.

[Ice Man]

I had my class one medical (totally unrestricted ) issued in 1987 with RBBB. Absolutely no problem at all. It turned out that my father has exactly the same and was also passed by Royal Air Force and CAA AME'S for years.

[QDMQDMQDM]

I must admit however, I feel like a hypocondriac. When I stand up from a rested position and my heart is pumping away to keep the blood in my head, i find my self thinking, is this an arrhythmia? Stupid I know. Everything starts to seem like it could be a symptom!

If you are wondering if the transient sensations you are experiencing are a supraventricular tachycardia or other arrhythmia related to WPW, then you almost certainly are not having one!

You would know, alright.

Good luck.

QDM

[aviationascent]

phew!

QDM,

I realise that all of what you are saying needs to be confirmed, yet, nevertheless, it is really uplifting to hear.

I am finding it alot easier to remain positive. So a note to say a big thanks for taking the time to respond, you make the waiting game much more bareable.

If anyone else has any other helpful experiences or knowlegde, keep it coming!

Happy cruising!

[Spotlight]

Aviationascent
WPW is not an uncommon syndrome. You are lucky in that due to flying you had to have an ECG at an early age and that if you have it, it has been picked up. WPW can and does cause instant death to quite fit individuals engaged in physically stressful activities such as surfing, football etc.

A laymans symptom is that you are aware of your heart operating by which I mean that you can feal it beating in your chest , speeding up and slowing down. Also, raceing after strenuous activity.

However, symptoms or not the ECG will show it. Followed by an Electrophysical study to identify the area of concern.

The good news! WPW is well understood by Cardiologists and a positive outcome is to be expected following RF Ablation, an unpleasant experience during which you will probably be awake, and if you are really tough and interested looking at a monitor while a catheter is guided via your groin to the heart and a number of HF 'burns' carried out to remove the offending pathway(s). This can be botched by the quacks with the subsequent EPS still showing WPS and a period of monthes required for damage caused by the botched burning to recover.

You should be out and about the next day wondering where that beating sensation in your chest has gone.

More good news! A letter from the treating cardiologist to CASA, with a recent annual medical will have you issued with a Class 1 medical certificate endorsed with Renew by Casa Only and a req for annual ECGs. This lasts for two years then you resume normal medical renewal status. Once you have a clear medical there it is a non issue with Airlines. RBBB can show up after corrective surgery on some of the rubbish diognostic ECG machines that many GPs have. Not a problem. For WPW you will learn to look at the Q wave.

So! Its tough. If you have Wilfred Hyde White Syndrome you are lucky it has been picked up. It can be fixed. Character building stuff.

Best of luck mate be positive and you will be right. Feel free to PM me if you want more info.

Oh by the way the term Golden Staph might be something a young fellow spending time in an Australian Hospital might take a passing interest in.

Edited to ad that I have just RTFQd and seen that CASA now want an initial six month review. No Muss.

[QDMQDMQDM]

Firstly it is Wolff-Parkinson-White sundrome, not 'Wilfred Hyde White'. Secondly, it is a very rare cause of sudden death, this fellow may well not have it anyway and you shouldn't be quite so alarmist.

This wikipedia article is quite good:

http://en.wikipedia.org/wiki/Wolff-P...White_syndrome

[aviationascent]

That sounds familiar...

Thank you all for your valuable feedback and time!

Bit of a worry that sometimes I feel like my heart is pumping really hard. It almost seems to make the entire left side of my chest pulsate. This seems to be congruent with what was said by spotlight. Perhaps I have unknowingly been having symptoms all my life but as a result, thought it was normal. Who knows.

No need to worry about alarming me, I am well aware of the worst case scenario and feel it's 'better the devil you know'. It also allows me to mentally prepare for all sorts of realities that I may be soon to face.

Like I say, everything is feeling like it might be a symptom, like just then when i took a deep breath and yawned, I got a sensation as though I had just stood up from being seated, (only lightly), and my heart seemed to beat stronger and from what I could tell, faster; even if only for a short while.

Go to see the Electro-cardio guy on April 11th. Just can't happen soon enough. And with regard to golden staph, I only just had surgery on my thumb after crushing it and severing a tendon, so I probably already have it!

Anyway, mainly a note to offer gratitude for everyones generousity with their time, feedback and empathy.

Cheers
Aviationascent

Also, what does RTFQd stand for?

[Spotlight]

QDM
At the risk of bruising your id, Wilfred Hyde White was an english character actor of some note. Among persons that exercise their minds and are socially adept such as surgeons, the similarity between WHW and WPW can be used as a mildly humerous aside. Not side splitting funny I grant but, a little tickle that I am sure most of us get.
WPW is a cause of sudden death and is under represented by statistics. Why could this be do you think?

As of this time WPW in any manner is a disqualifying condition for a pilot until rectified. Were I to be alarmist I could tell of the earlier treatment of open heart surgery and scalpels used to remove the extra pathways and the resultant scar tissue causing the pathways to return.

Hi aviatinascent. Chin up. Yes (mindful not to be alarmist) it can be that only after being fixed you realise that what you always thought was normal may not have been.

You will come across RTFQ very early on in aviation and it is extremely important. It means 'read the question', for that is where the correct answer lies.

[QDMQDMQDM]

At the risk of bruising your id, Wilfred Hyde White was an english character actor of some note. Among persons that exercise their minds and are socially adept such as surgeons, the similarity between WHW and WPW can be used as a mildly humerous aside. Not side splitting funny I grant but, a little tickle that I am sure most of us get.

Spotlight, your painful sense of humour and ho-hum air of superiority mark you down as a surgeon. If that is indeed the case, then thank God I'm not your anaesthetist or scrub nurse and I don't have to grimace politely at your ghastly jokes, repeated for the hundredth time as if they were new.

Every enthusiast for their particular rare cause of sudden death claims it is under-represented in the statistics. But how do they actually know? I see a fair number of young adults with SVTs. I see very, very few young adults dropping dead suddenly. It ain't common and undiagnosed HOCM is almost certainly way ahead of WPW or other aberrant pathway as a cause.

I stand by my statement that it is very important not to be alarmist with someone who has never had symptoms and in whom, so he says, the only evidence for WPW at the moment is incomplete RBBB and a possible delta wave in V4.

QDM