Demaret B
Hopital Universitaire Saint-Pierre, Bruxelles, Belgique.
Rev Int Serv Sante Forces Armees. 1997 Mar 15;70(1-3):13-7.
Recent epidemiological studies and new approaches in the management of atrial fibrillation (AF) incite to reconsider its incidence on medical aircrew certification. Paroxysmal as well as chronic AF are common diseases and are found among pilots particularly when advanced in years. It is usually associated with heart disease, especially with rheumatic valvulopathies. However idiopathic or "lone" AF is observed in subjects apparently-free of any heart disease. Mortality is twice higher in patient suffering from AF. It is responsible for miscellaneous symptoms among which palpitations or even syncope. Thromboembolism is however the most severe complication occurring even in cases of AF unrelated to rheumatic heart disease. Nevertheless, this risk would be less in paroxysmal AF and "lone" AF. The management of AF aims at restoring sinus rhythm and preventing recurrences or, at least, at controlling heart rate. Recurrences are frequent after cardioversion despite the use of antiarrhythmic drugs. Moreover the latter can induce adverse effects and are potentially proarrhythmogenic, which can lead to sudden death. Anticoagulant therapy significantly lowers the rate of cerebral embolism but at the risk of haemorrhages. New invasive techniques therapy are still experimental and can be responsible for severe complications. The risk of sudden incapacitation remains a reality in crew members suffering from AF. This increases with age, with frequency of the attacks or chronicity, in presence of heart disease or in case of antiarrhythmic or anticoagulant treatment. Paroxysmal forms have a lower rate of complications but are more frequently responsible for symptoms incompatible with flight, while chronic forms, although less symptomatic when heart rate is properly controlled, present more complications. Some cases of chronic idiopathic AF could be considered for restricted certification but submitted to regular follow-up. However, a pilot developing an isolated episode of AF triggered off by reversible conditions and free of risk factors has little chance of frequent recurrences or complications and might be eligible for flight.
近期的流行病学研究以及心房颤动（AF）管理的新方法促使人们重新审视其在医学空勤人员认证中的发生率。阵发性房颤以及慢性房颤都是常见疾病，在飞行员中尤为常见，尤其是在年龄较大时。它通常与心脏病有关，特别是风湿性瓣膜病。然而，在明显没有任何心脏病的受试者中也观察到特发性或“孤立性”房颤。房颤患者的死亡率高出两倍。它会导致各种症状，包括心悸甚至晕厥。然而，血栓栓塞是最严重的并发症，即使在与风湿性心脏病无关的房颤病例中也会发生。尽管如此，这种风险在阵发性房颤和“孤立性”房颤中会较低。房颤的管理旨在恢复窦性心律并预防复发，或者至少控制心率。尽管使用了抗心律失常药物，但复律后复发很常见。此外，后者可能会引起不良反应，并且具有潜在的促心律失常作用，可能导致猝死。抗凝治疗可显著降低脑栓塞的发生率，但有出血风险。新的侵入性技术治疗仍处于实验阶段，可能会导致严重并发症。房颤机组人员突然丧失能力的风险仍然是现实。随着年龄的增长、发作频率或慢性程度的增加、存在心脏病或进行抗心律失常或抗凝治疗时，这种风险会增加。阵发性房颤的并发症发生率较低，但更常导致与飞行不相容的症状，而慢性房颤虽然在心率得到适当控制时症状较少，但并发症更多。一些慢性特发性房颤病例可以考虑给予受限认证，但需定期随访。然而，一名因可逆性情况引发孤立性房颤发作且无危险因素的飞行员很少有频繁复发或并发症的可能，可能符合飞行条件。
