Drive + Fly

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Driving

Coronary Artery Disease (CAD)

Syndrome Private Commercial
STEMI 1 mo from D/C 3 mo from D/C
NSTEMI with sig LV damage 1 mo from D/C 3 mo from D/C
NSTEMI with PCI 48 h after PCI 7 days after PCI
NSTEMI without PCI 7 days after D/C 30 days after D/C
Unstable angina with PCI 48 h after PCI 7 days after PCI
Unstable angina without PCI 7 days after D/C 30 days after D/C
Stable angina or asymptomatic CAD No restriction No restriction
Stable CAD with PCI 48 h after PCI 7 days after PCI
CABG 1 mo after D/C 3 mo after D/C
Any, with 50% left main Disqualified until treated
Any, with 70% left main Disqualified until treated

Minor/non-significant LV damage is the abscence of new wall motion abnormality

Dysrhythmias

Syndrome Private Commercial
VF without reversible cause 6 mo after event Disqualified
Unstable VT 6 mo after event Disqualified
VT or VF with reversible cause Until cause is treated Until cause is treated
Sustained VT, LVEF <30% 3 mo after event & controlled Disqualified
Sustained VT, LVEF ≥30% 4 wk after event & controlled 3 mo after event
NSVT No restriction No restriction
Paroxysmal SVT/AF with impaired LOC When controlled When controlled
SVT/AF without impaired LOC No restriction No restriction
Symptomatic SSS Until treated Until treated

AF = atrial fibrillation or flutter

Heart Block

Syndrome Private Commercial
Isolated 1º HB No restriction No restriction
Isolated RBBB No restriction No restriction
Isolated LAFB No restriction No restriction
Isolated LPFB No restriction No restriction
LBBB If no impaired LOC If no impaired LOC*
Bifascicular block If no impaired LOC If no impaired LOC*
2º HB, Mobitz I If no impaired LOC If no impaired LOC*
1º HB with bifascicular block If no impaired LOC If no impaired LOC*
2º HB, Mobitz II Disqualified Disqualified
Alternating LBBB & RBBB Disqualified Disqualified
Acquired 3º HB Disqualified Disqualified
Congenital 3º HB If no impaired LOC If no impaired LOC**
  • and no higher block on annual 24 h Holter ** and QRS ≤110, and no pauses ≥3 sec on annual 24 H holter

Pacemakers and ICDs

Syndrome Private Commercial
PPM 1 wk after implant* 1 mo after implant*
ICD for 1º prophylaxis 4 wk after implant Disqualified
ICD for symptomatic VF/VT 6 mo after event Disqualified
ICD for sustained VT 1 wk after implant Disqualified
ICD giving shocks 6 mo after event Disqualified
  • as well as no impaired LOC, normal sensing and capture, and no evidence of PPM malfunction

Other Dysrhythmias

Syndrome Private Commercial
Brugada, long QT, or arrhythmogenic RV cardiomyopathy Once investigated Disqualified
Cather ablation 48 h after D/C 1 wk after D/C

Syncope

Syndrome Private Commercial
1x vasovagal No restriction No restriction
Treated cause (e.g. with PPM) 1 wk after treatment 1 mo after treatment
Reversible cause (e.g. dehydration) After treatment After treatment
Situational syncope with avoidable trigger 1 wk after episode 1 wk after episode
1x unexplained 1 wk after episode 12 mo after episode
Recurrent vasovagal in 12 mo 1 wk after episode 12 mo after episode
Recurrent unexplained in 12 mo 3 mo after episode 12 mo after episode
Due to arrhythmia See Dysrhythmia section See Dysrhythmia section

Valvular Disease

Syndrome Private Commerical
AS NYHA I or II with no impaired LOC Asymptomatic, NYHA I, AVA ≥1cm, EF ≥35%
AR/MS/MR NYHA I or II with no impaired LOC No impaired LOC, NYHA I, EF ≥35%
Mechanical valve
BioMVR or MV repair with AF
6 wk from D/C
No embolic, on A/C
3 mo from D/C
No embolic, on A/C, NYHA I, EF ≥35%
BioAVR
BioMVR or MV repair without AF
6 wk after D/C
No embolic
3 mo after D/C
No embolic, NYHA I, EF ≥35%

Heart Failure

Syndrome Private Commercial
NYHA I No restriction EF ≥35%
NYHA II No restriction EF ≥35%
NYHA III No restriction Disqualified
NYHA IV Disqualified Disqualified
Receiving inotropes Disqualified Disqualified
LVAD Disqualified Disqualified
Heart transplant 6 wk after D/C
NYHA I or II, on stable Rx
6 mo after D/C
EF ≥35%, NYHA I
No evidence of ischemia on testing

Hypertrophic Cardiomyopathy

  • Private: no impaired LOC
  • Commercial: LV wall thickness <30 mm, no syncope, no NSVT on annual 24 h Holter, no FHx sudden death at young age, and no hypotension with exercise

Flying

Condition NYHA Travel
Angina I/II No restriction
Angina III Supplemental oxygen required
Angina IV Only if medically necessary and accompanied
Recent MI I 1 to 2 weeks for repatriation if uncomplicated and revascularized
6 to 8 weeks for elective travel
Heart failure I/II Unrestricted
Heart failure III Supplemental oxygen required
Valvular disease I/II Unrestricted; supplemental oxygen if pulmonary hypertension
Valvular disease III Supplemental oxygen required
Valvular disease IV Only if medically necessary and accompanied
Congenital I/II Unrestricted; supplemental oxygen if PaO2 <70 mmHg
Congenital III Supplemental oxygen required
Congenital IV Only if medically necessary and accompanied
Recent CABG/valve surgery I/II 4 days post-surgery if Hb ≥90 and flight <2 h
7 days post-surgery if Hb ≥90 and flight ≤2 h
PCI/ASD closure I/II 1 day postprocedure
If PCI, following CAD guidelines, above
Post-arrhythmia procedure I/II Well-controlled SVT: unrestricted
1 day post-procedure for SVT
2 days post-procedure for ventricular arrhythmias
Post-arrhythmia procedure III/IV Uncontrolled hemodynamically significant ventricular arrhythmias should not fly
Post-PPM/ICD/loop recorder I/II 1 day post-implant if no pneumothorax, and device is functioning
ICD patients I/II 1 mo following last shock associated with severe presyncope or syncope

DVT Prophylaxis

Routine precautions include:

  • Avoid stasis, move around cabin, isometric calf exercises
  • Avoid dehydration, alcohol, and caffeine
Patient Population Recommendations
Flight <12 h Routine
Flight ≥12 h, low risk Routine
Flight ≥12 h, moderate risk Routine with pressure stockings or ASA 160-325 mg 4 h before flight
Flight ≥12 h, high risk Routine with pressure stockings or LMWH 2 h before flight
  • Moderate risk: patients aged >75 years, women >45 on estrogen, pregnant or post-partum women, age <45 years with heterozygous FVL or prothrombin mutations, patients with varicose veins, heart failure, MI within 6 weeks, or lower limb trauma within 6 weeks
  • High risk: previous VTE, major surgery within 6 weeks, active malignancy, gross obesity or marked immobility due to neuromuscular or cardiorespiratory disease, people age >45 with antithrombin/protein C/protein S deficiency, people age >75 with cardiac or pulmonary disease

Further Reading