Guide for Aviation Medical Examiners
Special Issuances

AME Assisted - All Classes
Atrial Fibrillation

First time waiver: If this is a first time issuance of an Authorization for the disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Renewal Waiver: AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation;
• The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
• A report of a current 24-hour Holter Monitor performed within last 90 days; and
• A minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months.

• Holter Monitor demonstrates: HR >120 BPM or Pauses >3 seconds;
• More than 20% of INR values are <2.0 or >3.0; or
• The applicant develops emboli, thrombosis, bleeding, or any other cardiac condition previously not diagnosed or reported.

  AME Assisted Special Issuance (AASI) is a process that whereby the FAA delegates power to your AME so that he or she has the ability to re-issue your airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization). This delegated authority will abpply to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
  (14 CFR) part 67.
  
  An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.

Note: Syncope (fainting), not satisfactorily explained or recurrent requires deferral (even though the syncope episode may be medically explained, an aeromedical certification decision may still be precluded). Syncope may involve cardiovascular, neurological, and psychiatric factors. AMEs will not immediately issue medical certificates if there are heart conditions that require deferral, or for any other cardiac condition that may result in sudden or subtle incapacitation. If the airman has one of these conditions, then the AME will consult with the FAA (AMCD) or the Regional Flight Surgeon. Medical documentation must be submitted for any of these cardiac conditions to support a possible waiver (special issuance) of an airman medical certificate.