{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:21:01Z","timestamp":1790018461793,"version":"4.0.1"},"reference-count":36,"publisher":"Aerospace Medical Association","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>\n                    <jats:bold>INTRODUCTION:<\/jats:bold>\n                    Cardiac rhythm and conduction abnormalities are common findings in aircrew and are a frequent cause of a loss of flying privileges. Given the great variety of electrophysiological disorders, risk assessment is challenging for the aviation medical examiner. For aeromedical assessment, important aspects of an electrophysiological evaluation are the presence or absence of symptoms and prognosis of the arrhythmia. In young fit people with increased vagal tone, some abnormal electrocardiogram findings are acceptable and do not require further investigation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>CASE SERIES:<\/jats:bold>\n                    This article provides recommendations for a stepwise screening approach and enhanced investigation of rhythm and conduction abnormalities for those which increase the risk to flight safety. Four cases of common arrhythmias are presented, namely premature ventricular complexes, nonsustained ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation. The most important factors for the aviation medical examiner regarding evaluation, treatment, and aeromedical assessment will be provided in a brief discussion of each case.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    This paper presents the current benchmark for assessing aircrew with rhythm and conduction abnormalities with data derived from current aeromedical and clinical literature, as well as the expert consensus of the NATO Working Groups on Occupational Cardiology (HFM WG 251, 316).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      Guettler N, Holdsworth D, Broekhuizen L, Syburra T, D\u2019Arcy J, Bron D, Manen O, Davenport E.\n                      <jats:italic>Cardiac rhythm and conduction abnormalities in aircrew<\/jats:italic>\n                      . Aerosp Med Hum Perform. 2026; 97(4):289\u2013295.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.6678.2026","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:30:29Z","timestamp":1774657829000},"page":"289-295","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac Rhythm and Conduction Abnormalities in Aircrew"],"prefix":"10.3357","volume":"97","author":[{"given":"Norbert","family":"Guettler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Holdsworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lysette","family":"Broekhuizen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Syburra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"D\u2019Arcy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Bron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Manen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddie","family":"Davenport","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1911","reference":[{"key":"B1","series-title":"Hippokratia.","first-page":"53","article-title":"Arrhythmias, sudden cardiac death and incapacitation of pilots","volume":"12","author":"Mantziari L","year":"2008","unstructured":"Mantziari L, Styliadis C, Kourtidou-Papadeli C, Styliadis I. 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[in German]."},{"issue":"8","key":"B5","series-title":"Aviat Space Environ Med.","first-page":"688","article-title":"Arrhythmias observed during high-G training: proposed training safety criterion","volume":"75","author":"Hanada R","year":"2004","unstructured":"Hanada R, Hisada T, Tsujimoto T, Ohashi K. Arrhythmias observed during high-G training: proposed training safety criterion. Aviat Space Environ Med. 2004 Aug; 75(8):688\u201391."},{"key":"B6","series-title":"Heart.","first-page":"s38","article-title":"Management of cardiac conduction abnormalities and arrhythmia in aircrew","volume":"105","author":"Guettler N","year":"2019","unstructured":"Guettler N, Bron D, Manen O, Gray G, Syburra T,  Management of cardiac conduction abnormalities and arrhythmia in aircrew. Heart. 2019 Jan; 105(Suppl 1):s38\u201349."},{"key":"B7","article-title":"Aerospace medicine waiver guide","author":"Van Syoc D","year":"2025","unstructured":"Van Syoc D, Davenport E. Aerospace medicine waiver guide. Wright-Patterson AFB (OH): U.S. Air Force School of Aerospace Medicine; 2025. Condition: ectopy, supraventricular and ventricular, and pairing (Sep 2015). [Accessed 2025 Aug 1]. Available from https:\/\/www.afrl.af.mil\/711HPW\/USAFSAM\/."},{"issue":"9","key":"B8","series-title":"N Engl J Med.","first-page":"781","article-title":"Frequent ventricular ectopy after exercise as a predictor for death","volume":"348","author":"Frolkis JP","year":"2003","unstructured":"Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor for death. 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Eur Heart J. 2021 Feb 1; 42(5):373\u2013498."},{"issue":"21","key":"B17","series-title":"J Am Coll Cardiol.","first-page":"e1-76","article-title":"2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society","volume":"64","author":"January CT","year":"2014","unstructured":"January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE,  2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. 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Aviat Space Environ Med. 2004 Aug; 75(8):688\u201391."},{"key":"B6","series-title":"Heart.","first-page":"s38","article-title":"Management of cardiac conduction abnormalities and arrhythmia in aircrew","volume":"105","author":"Guettler N","year":"2019","unstructured":"Guettler N, Bron D, Manen O, Gray G, Syburra T,  Management of cardiac conduction abnormalities and arrhythmia in aircrew. Heart. 2019 Jan; 105(Suppl 1):s38\u201349."},{"key":"B7","article-title":"Aerospace medicine waiver guide","author":"Van Syoc D","year":"2025","unstructured":"Van Syoc D, Davenport E. Aerospace medicine waiver guide. Wright-Patterson AFB (OH): U.S. Air Force School of Aerospace Medicine; 2025. Condition: ectopy, supraventricular and ventricular, and pairing (Sep 2015). [Accessed 2025 Aug 1]. Available from https:\/\/www.afrl.af.mil\/711HPW\/USAFSAM\/."},{"issue":"9","key":"B8","series-title":"N Engl J Med.","first-page":"781","article-title":"Frequent ventricular ectopy after exercise as a predictor for death","volume":"348","author":"Frolkis JP","year":"2003","unstructured":"Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor for death. N Engl J Med. 2003 Feb 27; 348(9):781\u201390."},{"issue":"1","key":"B9","series-title":"J Cardiovasc Magn Reson.","first-page":"48","article-title":"Cardiac MRI improves cardiovascular risk stratification in hazardous occupations","volume":"21","author":"Holdsworth DA","year":"2019","unstructured":"Holdsworth DA, Parsons IT, Chamley R, Britton J, Pavitt C,  Cardiac MRI improves cardiovascular risk stratification in hazardous occupations. J Cardiovasc Magn Reson. 2019 Jul 29; 21(1):48."},{"issue":"7","key":"B10","series-title":"Heart Rhythm.","first-page":"865","article-title":"Relationship between burden of premature ventricular complexes and left ventricular function","volume":"7","author":"Baman TS","year":"2010","unstructured":"Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu T-Y,  Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010 Jul; 7(7):865\u20139."},{"issue":"8","key":"B11","series-title":"Aviat Space Environ Med.","first-page":"783","article-title":"Nonsustained ventricular tachycardia in 193 U.S. military aviators: long-term follow-up","volume":"71","author":"Gardner RA","year":"2000","unstructured":"Gardner RA, Kruyer WB, Pickard JS, Celio PV. Nonsustained ventricular tachycardia in 193 U.S. military aviators: long-term follow-up. Aviat Space Environ Med. 2000 Aug; 71(8):783\u201390."},{"issue":"40","key":"B12","series-title":"Eur Heart J.","first-page":"3997","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld K","year":"2022","unstructured":"Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER,  2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21; 43(40):3997\u20134126."},{"issue":"5","key":"B13","series-title":"Eur Heart J.","first-page":"655","article-title":"2019 ESC guidelines for the management of patients with supraventricular tachycardia. The task force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)","volume":"41","author":"Brugada J","year":"2020","unstructured":"Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ,  2019 ESC guidelines for the management of patients with supraventricular tachycardia. The task force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020 Feb 1; 41(5):655\u2013720."},{"issue":"11","key":"B14","series-title":"Aviat Space Environ Med.","first-page":"1055","article-title":"Electrocardiographic abnormalities in medically screened military aircrew","volume":"83","author":"Boos CJ","year":"2012","unstructured":"Boos CJ, Jamil Y, Park M, Moy W, Khanna V,  Electrocardiographic abnormalities in medically screened military aircrew. Aviat Space Environ Med. 2012 Nov; 83(11):1055\u20139."},{"issue":"12","key":"B15","series-title":"Aviat Space Environ Med.","first-page":"1249","article-title":"A 5-year review of atrial fibrillation in military aircrew","volume":"84","author":"Hunter AH","year":"2013","unstructured":"Hunter AH, Timperley AC, Reid ANC, McLoughlin DC, Nicol E. A 5-year review of atrial fibrillation in military aircrew. Aviat Space Environ Med. 2013 Dec; 84(12):1249\u201354."},{"issue":"5","key":"B16","series-title":"Eur Heart J.","first-page":"373","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks G","year":"2021","unstructured":"Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ,  2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. 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