Atrial and premature ventricular, or ectopic beats, are common findings on routine ECG. Frequently benign, their presence may however suggest the possibility of aeromedically significant arrhythmia or underlying cardiomyopathy.
The finding of no more than one atrial premature beat or one ventricular premature beat on a routine ECG is acceptable without further investigations.
Atrial ectopic beats are common and mostly harmless unless very frequent, or sustained. Holter monitoring is helpful in detecting the presence of sino-atrial disease and any tachycardia of aeromedical significance.
Ventricular premature beats are also usually harmless if infrequent, unifocal and the heart is anatomically normal. Couplets, multifocal ectopics and bouts of tachycardia not exceeding 120 bpm may still be acceptable following detailed specialist assessment.
On the first occasion that symptomatic or frequent ectopy is diagnosed, a 24h Holter monitor;
On subsequent occasions:
An applicant with a history of relevant symptoms (distraction, dizziness, fainting), couplets or runs, multifocal premature beats, abnormal heart anatomy, or abnormal 24h Holter, should be considered as having a condition that is of aeromedical significance;
An applicant with more than one premature beat on the ECG but no more than 2% premature beats on a 24h Holter, may be assessed as having a condition that is not of aeromedical significance, if there is no suspicion of underlying heart disease;
An applicant previously investigated for premature beats that were considered not aeromedically significant, may be considered as having a condition that is not of aeromedical significance if there has been no suspected change in condition;
An applicant with no more than one premature beat on the ECG may be considered as having a condition that is not of aeromedical significance.