Cardiac Rhythm and Conduction Abnormalities in Aircrew.

Cardiac rhythm and conduction abnormalities are common findings in aircrew and are a frequent cause of loss of flying privileges.

• The great variety of electrophysiological disorders makes risk assessment challenging for aviation medical examiners.
• Important aspects of electrophysiological evaluation include the presence or absence of symptoms and the prognosis of the arrhythmia.
• Recommendations are derived from current aeromedical and clinical literature as well as expert consensus of NATO Working Groups on Occupational Cardiology (HFM WG 251, 316).

In young fit people with increased vagal tone, some abnormal ECG findings are acceptable and do not require further investigation.

• Vagal tone-related ECG abnormalities in young, fit individuals are considered benign in the aeromedical context.
• The paper provides recommendations for a stepwise screening approach to distinguish benign findings from those requiring enhanced investigation.
• Only rhythm and conduction abnormalities that increase the risk to flight safety require further workup.

A stepwise screening and investigation approach is recommended for rhythm and conduction abnormalities that increase the risk to flight safety.

• The recommended approach involves initial screening followed by enhanced investigation for higher-risk findings.
• Four cases of common arrhythmias are presented: premature ventricular complexes, nonsustained ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation.
• Each case discussion covers evaluation, treatment, and aeromedical assessment considerations for the aviation medical examiner.

Premature ventricular complexes, nonsustained ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation are identified as common arrhythmias requiring aeromedical consideration in aircrew.

• These four arrhythmia types were selected as representative cases for detailed discussion.
• Each case addresses the most important factors for the aviation medical examiner regarding evaluation, treatment, and aeromedical assessment.
• The aeromedical assessment framework draws on both clinical and aviation-specific literature.

The paper establishes a current benchmark for assessing aircrew with rhythm and conduction abnormalities based on NATO working group expert consensus.

• Data were derived from current aeromedical and clinical literature as well as expert consensus of the NATO Working Groups on Occupational Cardiology (HFM WG 251, 316).
• The recommendations are intended to guide aviation medical examiners in managing electrophysiological disorders in aircrew.
• The paper was published in Aerospace Medicine and Human Performance in 2026, volume 97, issue 4, pages 289–295.