After a Cardiac Event

Returning to the cockpit after a myocardial infarction (heart attack), coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI/stent placement), valve surgery, or significant arrhythmia diagnosis is possible through the FAA's Special Issuance process — but it requires thorough documentation and patience. The FAA's primary concern is assessing the risk of sudden incapacitation, and the evaluation framework is designed to ensure that your cardiac condition is stable, well-treated, and unlikely to cause an in-flight emergency.

The specific requirements vary by the type of cardiac event and procedure. For pilots who have had a myocardial infarction or coronary revascularization (bypass surgery or stent placement), the FAA generally requires a minimum recovery period of 6 months from the event, followed by a comprehensive cardiovascular evaluation. This evaluation typically includes a maximal-effort exercise stress test (Bruce protocol or equivalent), a nuclear perfusion imaging study or stress echocardiogram to assess for residual ischemia, a resting echocardiogram documenting left ventricular ejection fraction (LVEF), 24-hour Holter monitoring to screen for arrhythmias, and a detailed status report from your treating cardiologist.

For arrhythmia-related special issuances — including atrial fibrillation, supraventricular tachycardia (SVT), or other rhythm disorders — the FAA requires documentation of the specific arrhythmia, treatment approach (medication, ablation, or cardioversion), and evidence of rhythm stability. Implantable cardioverter-defibrillators (ICDs) are permanently disqualifying for all classes of FAA medical certificate because of the risk of device discharge causing incapacitation. Pacemakers may be certifiable under specific conditions with documentation from an electrophysiologist. Pilots with atrial fibrillation must demonstrate controlled ventricular rate and be on an FAA-acceptable anticoagulation regimen if indicated.