Arrhythmia Medication

Guidance material issued by the UK CAA Medical Department in relation to medication acceptable for heart arrhythmias.

Medication for Cardiac Arrhythmias

Amiodarone

Class 1 - Amiodarone is unacceptable for Class 1 medical certification.

Class 2 –Usually requires a VCL (day time flying only) limitation. If the applicant does not experience glare at night (usually noticed when they are driving) then, subject to a satisfactory AMS ophthalmological review, unrestricted Class 2 medical certification may be possible (i.e. night flying is permitted).

See also Atrial Fibrillation flow chart


Flecainide:

Flecainide, used for the treatment of atrial fibrillation, may be acceptable.  Some patients experience mild ocular side effects. Most commonly, up to 14% of patients may develop small corneal deposits1.  These are asymptomatic and usually have no implications for vision1,2.  Less commonly, mild blurry vision on extreme lateral gaze may occur due to an effect on the vestibular apparatus2, rather than on the eye itself.  Pilots complaining of blurred vision on lateral gaze who found to have nystagmus should undergo tests of vestibular function2 rather than further ophthalmological review.

No studies have shown abnormal visual function with flecainide.  Ophthalmological review is only indicated if reduced visual function is clinically indicated; there is no case for routine ophthalmological screening of pilots on flecainide.


Note: Flecanide is not acceptable for certification if used for the treatment of ventricular arrhythmias even in a structurally normal heart – Medical Advisory Panel recommendation (2006).



References

1. Moller HU, Thygesen K, Kruit PJ. Corneal deposits associated with flecainide. BMJ 1991; 302 (6775): 506-7
2. Ikaheimo K, Kettuven R, Montyjarvi M. Adverse ocular effects of flecainide. Acta Ophthal Scand 2001; 79 (2): 175-6