Procedure to gain recertification following pacemaker insertion
The normal heartbeat originates as an electrical impulse in a natural “pacemaker”, a collection of specialised conducting cells in one of the upper chambers of the heart (the right atrium). As the impulse travels from the upper to the lower chambers (the ventricles) there is a contraction of the heart muscle, which pumps blood out of the heart to the lungs and the rest of the body. If this natural pacemaker fails, or if there is a failure of conduction of the electrical impulse, then heart muscle contraction does not occur and blood does not circulate. If this pause in the circulation is prolonged, incapacitation can occur. Clearly this is not a situation that is acceptable in pilots or ATCOs.
A pilot/ATCO who is suspected of having or is likely to have such pauses will be assessed as unfit and will undergo a series of heart tests. These should reveal no obvious abnormality or cause of the heart rhythm disturbance. For such applicants the fitting of an artificial heart pacemaker, which senses a pause and then stimulates the heart to beat, may allow a return to flying/controlling. However the applicant’s heart must not be “pacemaker dependent”. When all the heart beats are initiated by the artificial pacemaker, and if it stops, so does the heart. The artificial pacemaker should only be there as a precautionary measure to protect against a prolonged period without a heart beat which could lead to incapacitation.
The artificial pacemaker is an electronic device which can generate a pulse of electricity. It is powered by a battery that can last for many years. It is usually positioned just under the skin in the upper chest. Wires are led to the heart chambers via a vein, and anchored to the muscle wall. They sense the normal heart beat, and initiate an artificial beat if the normal one fails. It is important that both positive and negative electrodes are placed within the heart itself (bipolar electrodes) as this minimises any interference from external electromagnetic waves, which could occur in an aircraft cockpit.
The protocols following a pacemaker insertion are given below.