Atrial fibrillation
What the FAA's documents say about atrial fibrillation, in plain words, with the FAA's own words one press away.
FAA term: Atrial Fibrillation (AFib)/A-FlutterCovers: All classes
Short version
The disposition table has four rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row APreviously reported, with an FAA letter | Examiner issues | Examiner can issue |
| Row BPreviously warned, now with a new event or findings | Defers to the FAA | Special Issuance |
| Row CNon-valvular AFib or A-flutter, at any time or now | Defers to the FAA | Special Issuance |
| Row DTreated with a left atrial appendage closure device | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Atrial fibrillation
- Row A · Examiner can issue
Previously reported to the FAA, and the pilot has a letter from the FAA that monitoring is not required. The table says the pilot should bring the FAA's letter or letters for this condition for the examiner to review. If the examiner's history and exam do not reveal any evidence or concern of recurrence, the table says ISSUE, and has the examiner summarize this history in Block 60.
Previously reported to FAA and the airman has a letter from the FAA that monitoring is not required. … The airman should bring his/her letter(s) from the FAA (for this condition) for the AME to review. … If the AME’s history and exam do not reveal any evidence or concern of recurrence: ISSUE … Summarize this history in Block 60.
- Row B · Special Issuance
Previously warned, and now with a new event or findings. The table lists what to submit to the FAA for review -- the status summary, detailed clinical progress notes from the treating physician or physicians describing the new event or finding, and a current cardiac monitor of 24 hours or more. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Previously warned; Now with New event or Findings: … Submit the following to the FAA for review: … Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary AND Detailed clinical progress notes from the treating physician(s) describing the new event or finding. … PLUS: … Current ≥ 24-hour cardiac monitor. … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · Special Issuance
A history at any time, or current, of non-valvular AFib or A-flutter: single or multiple episodes; paroxysmal, persistent, or permanent/chronic; untreated or treated; and AFib treated with ablation (a 3-month recovery period) or cardioversion (a 1-month recovery period). The table says to use this row for atypical, symptomatic, or untreated atrial flutter. The table lists what to submit to the FAA for review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
Non-Valvular AFib/A-Flutter History of at any time OR current: Single or multiple episodes Paroxysmal Persistent Permanent/chronic Untreated or treated AFib treated with ablation (3-month recovery period) or cardioversion (1-month recovery period) Use this row for Atypical, symptomatic, or untreated atrial flutter … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row D · Special Issuance
Treated with a left atrial appendage (LAA) closure device, for example Watchman. After a three-month recovery period, the table lists what to submit to the FAA for review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Treated with left atrial appendage (LAA) closure device ex: Watchman … After a three (3)-month recovery period, submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- A note on the table, 1
For rows B, C and D, the table says a follow-up Special Issuance will be per the pilot's own authorization letter, and row C says to see the status summary.
Follow-up Special Issuance – Will be per the Airman’s authorization letter … See Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary
The FAA pathways for atrial fibrillation
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: Your FAA letter
Row A: the letter the examiner reviews.Your letter or letters from the FAA for this condition, saying monitoring is not required, for your AME to review.
Show the FAA's words: Your FAA letter
Previously reported to FAA and the airman has a letter from the FAA that monitoring is not required.
The airman should bring his/her letter(s) from the FAA (for this condition) for the AME to review.
FAA source: Atrial Fibrillation Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner's history and exam do not reveal any evidence or concern of recurrence, the table says ISSUE, and has the examiner summarize this history in Block 60.Exam day- If the examiner's history and exam do not reveal any evidence or concern of recurrence, the table says ISSUE, and has the examiner summarize this history in Block 60.
Show the FAA's words: See your AME
Previously reported to FAA and the airman has a letter from the FAA that monitoring is not required.
The airman should bring his/her letter(s) from the FAA (for this condition) for the AME to review.
If the AME’s history and exam do not reveal any evidence or concern of recurrence: ISSUE
Summarize this history in Block 60.
FAA source: Atrial Fibrillation Disposition Table. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
If the examiner's history and exam do not reveal any evidence or concern of recurrence, the table says ISSUE, and has the examiner summarize this history in Block 60.
Row BDefers to the FAASpecial Issuance
The table lists what to submit to the FAA for review -- the status summary, detailed clinical progress notes from the treating physician or physicians describing the new event or finding, and a current cardiac monitor of 24 hours or more. The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow CDefers to the FAASpecial Issuance
The table lists what to submit to the FAA for review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow DDefers to the FAASpecial Issuance
After a three-month recovery period, the table lists what to submit to the FAA for review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Previously reported to the FAA, and the pilot has a letter from the FAA that monitoring is not required. The table says the pilot should bring the FAA's letter or letters for this condition for the examiner to review. If the examiner's history and exam do not reveal any evidence or concern of recurrence, the table says ISSUE, and has the examiner summarize this history in Block 60.
Previously reported to FAA and the airman has a letter from the FAA that monitoring is not required. … The airman should bring his/her letter(s) from the FAA (for this condition) for the AME to review. … If the AME’s history and exam do not reveal any evidence or concern of recurrence: ISSUE … Summarize this history in Block 60.
- Row B · Special Issuance
Previously warned, and now with a new event or findings. The table lists what to submit to the FAA for review -- the status summary, detailed clinical progress notes from the treating physician or physicians describing the new event or finding, and a current cardiac monitor of 24 hours or more. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Previously warned; Now with New event or Findings: … Submit the following to the FAA for review: … Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary AND Detailed clinical progress notes from the treating physician(s) describing the new event or finding. … PLUS: … Current ≥ 24-hour cardiac monitor. … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · Special Issuance
A history at any time, or current, of non-valvular AFib or A-flutter: single or multiple episodes; paroxysmal, persistent, or permanent/chronic; untreated or treated; and AFib treated with ablation (a 3-month recovery period) or cardioversion (a 1-month recovery period). The table says to use this row for atypical, symptomatic, or untreated atrial flutter. The table lists what to submit to the FAA for review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
Non-Valvular AFib/A-Flutter History of at any time OR current: Single or multiple episodes Paroxysmal Persistent Permanent/chronic Untreated or treated AFib treated with ablation (3-month recovery period) or cardioversion (1-month recovery period) Use this row for Atypical, symptomatic, or untreated atrial flutter … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row D · Special Issuance
Treated with a left atrial appendage (LAA) closure device, for example Watchman. After a three-month recovery period, the table lists what to submit to the FAA for review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Treated with left atrial appendage (LAA) closure device ex: Watchman … After a three (3)-month recovery period, submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
If the examiner defersSpecial Issuance
Row B, previously warned and now with a new event or findings, is marked DEFER.
Row C, a history at any time or current non-valvular AFib or A-flutter, is marked DEFER.
Row D, treatment with a left atrial appendage closure device, is marked DEFER.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
Row B, previously warned and now with a new event or findings, is marked DEFER.
Previously warned; Now with New event or Findings: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 2
Row C, a history at any time or current non-valvular AFib or A-flutter, is marked DEFER.
Non-Valvular AFib/A-Flutter History of at any time OR current: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 3
Row D, treatment with a left atrial appendage closure device, is marked DEFER.
Treated with left atrial appendage (LAA) closure device ex: Watchman … DEFER Submit the information to the FAA for a possible Special Issuance.
After the FAA decides
AASIThe AASI says an FAA physician provides the initial certification decision and grants the Authorization, and that examiners may then reissue under the Authorization if the pilot provides what it lists. The table says a follow-up Special Issuance will be per the pilot's own authorization letter.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
Follow-up Special Issuance – Will be per the Airman’s authorization letter
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
ATRIAL FIBRILLATION (AFIB)/A-FLUTTER All Classes
Under an Authorization, the AASI lists what the pilot provides for the examiner to reissue -- the Authorization granted by the FAA; a report of a minimum 24-hour cardiac monitor performed within the last 90 days; and a completed status summary and a cardiologist evaluation that addresses all items on it.
Show the FAA's words: at later exams
Examiners 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 report of a minimum 24-hour cardiac monitor performed within last 90 days. … A completed Non-Valvular Atrial Fibrillation (AFIB)/A-Flutter Status Summary ( PDF ) AND a cardiologist evaluation that addresses all items on the status report; and
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI's list for a reissue begins with the Authorization granted by the FAA.
Show the FAA's words: The Authorization granted by the FAA
Examiners 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 report of a 24-hour or longer cardiac monitor
The AASI asks for a report of a minimum 24-hour cardiac monitor performed within the last 90 days. It says the report must be submitted even if findings are normal, and should include the 1-page computerized summary and the representative full-scale multi-lead ECG tracings.
Show the FAA's words: A report of a 24-hour or longer cardiac monitor
A report of a minimum 24-hour cardiac monitor performed within last 90 days. (Cardiac monitor report must be submitted, even if findings are normal, and should include 1-page computerized summary and the representative full-scale multi-lead ECG tracings);
The completed status summary and a cardiologist evaluation
The AASI asks for a completed Non-Valvular Atrial Fibrillation (AFIB)/A-Flutter Status Summary and a cardiologist evaluation that addresses all items on the status report.
Show the FAA's words: The completed status summary and a cardiologist evaluation
A completed Non-Valvular Atrial Fibrillation (AFIB)/A-Flutter Status Summary ( PDF ) AND a cardiologist evaluation that addresses all items on the status report; and
What the data verifies
The AASI says the data verifies, if all items on the status summary are in the left-hand column or reports verify: no interval evidence or suspicion of stroke, TIA, or other thromboembolic event; heart rate well controlled on the cardiac monitor by cardiologist interpretation; whether symptom, rate, or rhythm control is indicated and, if so, a description of how it is managed (the sheet prints "how it this is managed"); and, when the CHA2DS2-VASc score is 2 or more, that emboli mitigation is in place without side effects. For that line it says to see the Pharmaceuticals - Anticoagulants - Emboli Mitigation sheet.
Show the FAA's words: What the data verifies
The above data verifies … If all items on the Non-Valvular Atrial Fibrillation (AFIB)/A-Flutter Status Summary ( PDF ) are in the left-hand column OR reports verify: … No interval evidence or suspicion of stroke, TIA, or other thromboembolic event. … Heart rate is well controlled on cardiac monitor by cardiologist interpretation. … If symptom, rate, or rhythm control is indicated and, if so, a description of how it this is managed. … When CHA2DS2-VASc score ≥ 2, verify emboli mitigation is in place without side effects. See Pharmaceuticals - Anticoagulants - Emboli Mitigation ( PDF ) .
What the Authorization letter comes with
The AASI says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI says the examiner must defer to the AMCD or Region if the pilot had left atrial appendage (LAA) occlusion (Watchman) or excision or developed a new cardiac condition; if there has been an interval definitive or suspicious thromboembolic event; if the cardiology interpretation indicates questionable or poor rate control (average heart rate over 100, maximum non-exercise over 120, or a single pause over 3 seconds); if there is evidence that symptoms, rate, or rhythms are not well controlled; if CHA2DS2-VASc is 2 or more and emboli are not mitigated; and/or if there was interval bleeding that required medical intervention. On emboli mitigation it adds that acceptable mitigation under an AASI authorization is anti-coagulation with either NOAC/DOAC/warfarin, and, for warfarin/Jantoven, names more than 20% of INR values below 2.0 or above 3; the sheet's sentence ends there.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … Applicant had left atrial appendage (LAA) occlusion (Watchman)/excision or developed a new cardiac condition; … There has been an interval definitive or suspicious thromboembolic event; … Cardiology interpretation indicates questionable or poor rate control. Average heart rate is > 100, maximum (non-exercise) is > 120, or a single pause is > 3 seconds; … Evidence that symptoms, rate, or rhythms are not well controlled; … CHA2DS2-VASc ( PDF ) is ≥ 2 and emboli not mitigated; (Acceptable emboli mitigation under AASI authorization is anti-coagulation with either NOAC/DOAC/warfarin. When using warfarin/Jantoven, if more than 20% of INR values are less than 2.0 or greater than 3.); and/or … Interval bleeding that required medical intervention.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Ablation and cardioversion carry recovery periods
Row C names AFib treated with ablation, with a 3-month recovery period, or cardioversion, with a 1-month recovery period. The table marks row C DEFER.
Show the FAA's words: good to know, 2
AFib treated with ablation (3-month recovery period) or cardioversion (1-month recovery period) … DEFER Submit the information to the FAA for a possible Special Issuance.
Atypical or untreated atrial flutter uses row C
The table says to use row C for atypical, symptomatic, or untreated atrial flutter.
Show the FAA's words: good to know, 3
Use this row for Atypical, symptomatic, or untreated atrial flutter
The sleep study must be Type I or Type II
The work-up's sleep study meets current AASM or CMS guidelines for a Type I or Type II sleep study. The table says Type III or Type IV is not allowed.
Show the FAA's words: good to know, 4
Sleep Study that meets current AASM or CMS Guidelines for a Type I or Type II sleep study (Type III or Type IV NOT allowed);
The monitor report goes in even if normal
The status summary says the 1-page computerized summary and the representative full-scale multi-lead ECG tracings must be submitted even if findings are normal. The AASI says the same of its cardiac monitor report.
Show the FAA's words: good to know, 5
You must submit the 1-page computerized summary and the representative full-scale multi-lead ECG tracings, EVEN IF FINDINGS ARE NORMAL.
(Cardiac monitor report must be submitted, even if findings are normal, and should include 1-page computerized summary and the representative full-scale multi-lead ECG tracings);
Ablation for AFib points back here
The Item 36 Arrhythmias page's Radio Frequency Ablation row says that if it was performed for atrial fibrillation, see the AFib/A-Flutter section first.
Show the FAA's words: good to know, 6
Radio Frequency Ablation … * If performed for atrial fibrillation AFib/A-Flutter ( PDF ) , see that section first.
The first AASI is deferred to the FAA
When this is a first-time application for this AASI and the pilot has all the requisite medical information necessary for a determination, the AASI says the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 7
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Two FAA documents score age 75 differently
The status summary's CHA2DS2-VASc table prints "Age > = 75" with a score of 2. The Emboli Mitigation sheet's table prints "Age > 75" with a score of 2. Both are shown as each document publishes them.
Show the FAA's words: good to know, 8
Congestive heart failure 1 Hypertension 1 Age > = 75 2
CHA2DS2-VASc Score Congestive heart failure 1 Hypertension 1 Age > 75 2
Two FAA documents give different warfarin figures
The status summary says warfarin (Jantoven) requires 6 weeks of stabilization with 80% of INRs between 2.0 and 3.0, and asks for a copy of the last 6 monthly INR values. The Emboli Mitigation sheet, for applicants just beginning warfarin, lists a minimum observation time of 6 weeks after starting it and 6 INRs, no more frequently than 1 per week, and says 80% or more of INR values should be between 2.0 and 3.0. The two figures are shown as each document publishes them.
Show the FAA's words: good to know, 9
Warfarin (Jantoven) requires 6 weeks of stabilization with 80% of INRs between 2.0 and 3.0. Submit a copy of the last 6 monthly INR values.
Warfarin (Jantoven): For applicants who are just beginning warfarin (Jantoven) treatment the following is required: Minimum observation time of 6 weeks after initiation of warfarin therapy; Must also meet any required observation time for the underlying condition; AND 6 INRs, no more frequently than 1 per week o 80% or more of INR values should be between 2.0 and 3.0.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Atrial Fibrillation Disposition TableOpen to print: Atrial Fibrillation Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open to print: AASI – Atrial Fibrillation, a page at the FAA, in a new tab
- Open at the FAA: Non-Valvular Atrial Fibrillation (AFIB)/A-Flutter Status Summary, a PDF at the FAA, in a new tab
- Open at the FAA: Emboli Mitigation in Atrial Fibrillation, a PDF at the FAA, in a new tab
- Open at the FAA: Item 36 – Arrhythmias, a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.