Wolff-Parkinson-White症候群等，房室頻脈性不整脈の航空医 学適性評価及び判定法に関する検討

摘要

In this review, we defined the mechanisms by which macro-reentry circuits in the atrioventricular region evoke paroxysmal supraventricular tachycardia as "atrioventricular tachyarrhythmias (AVT)" and hemodynamic aberrance, based on AVT as "hemodynamic phenomena (HDP)". HDP is an aeromedical concern among pilots who become incapacitated during flight. The assessment of aeromedical fitness, hereafter referred to as "fitness", of the pilot should be performed with caution in order to obtain precise clinical findings. Herein, we propose methods to evaluate and assess aeromedical fitness of pilots for AVT, based on our review of the literature. In cases with a history of HDP, when all of the reentry circuits are presumed as being functional based upon an electrophysiological study (EPS), in principle the pilot is qualified as exhibiting fitness without restriction, otherwise the pilots are not considered fit. In cases with Wolff-Parkinson-White (WPW) syndrome without a history of HDP and EPS, those pilots aged 40 years or more, exhibit fitness restricted to low-G aircraft. If the pilot is less than 40 years of age, they would have fitness restricted to multicrew operations and low-G aircraft. To remove the restriction, the following procedures may be performed ；1) exhibiting both a QRS<=120 msec and Rosenbaum type B on electrocardiography, which would indicate a fasciculoventricular pathway (FVP) that would not develop to HDP ； 2) The characteristic waveform is presumed from FVP based on no alteration in the QRS waveform using Holter electrocardiogram or adenosine test ； and 3) long anterograde effective refractory period is presumed based on intermittent WPW syndrome or disappearance of the delta wave on exercise testing. In cases with Lown-Ganong-Levine syndrome, which we defined as sustained PR interval<110 msec despite repeated testing, without a history of HDP and EPb, the pilot would have fitness restricted to multicrew operations and low-G aircraft. To remove the restriction, the observation of no alteration in the QRS waveform on Holter electrocardiogram or adenosine test, which is presumed as not having any-apparent alternative pathway, may be performed.