Bundle branch block (BBB)
What the FAA's documents say about bundle branch block (BBB), in plain words, with the FAA's own words one press away.
Show the FAA's words: which classes the FAA's table covers
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB)
- The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines, and does not name them. Crosscheck has a page on coronary heart disease, whose FAA name includes coronary artery disease (CAD).
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Complete RBBB, age 35 or youngerA complete RBBB identified at age 35 or younger | Examiner issues | Examiner can issue |
| Complete RBBB, age 36 or olderA complete RBBB identified at age 36 or older (or other indication) | Examiner issues | Examiner can issue |
| LBBB, any ageA LBBB at any age | Examiner issues | Examiner can issue |
Show the FAA's words: the FAA's table for Bundle branch block (BBB)
- Complete RBBB, age 35 or younger · Examiner can issue
A complete right bundle branch block (RBBB) identified at age 35 or younger. The protocol says that if otherwise healthy, it will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication, and the examiner annotates Block 60. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
RIGHT (RBBB): If a complete RBBB is identified at: … Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). Annotate Block 60.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
- Complete RBBB, age 36 or older · Examiner can issue
A complete right bundle branch block (RBBB) identified at age 36 or older (or other indication). The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a stress echo. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
RIGHT (RBBB): If a complete RBBB is identified at: … Age 36 or older (or other indication) - Will require a cardiac evaluation to include: CVE ( PDF ) = Narrative + lab (hemoglobin A1C + current Lipid Panel) Stress echo … AME ACTIONS: Individuals with a negative work-up may be issued the appropriate class of medical certificate with notes in Item 60 and submission of evaluation documents for retention in the file.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
- LBBB, any age · Examiner can issue
A left bundle branch block (LBBB) in a person of any age. The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a pharmaceutical radionuclide perfusion study. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
LEFT (LBBB): A LBBB in a person of any age will require a cardiac evaluation to include: CVE ( PDF ) = Narrative + lab (hemoglobin A1C + current Lipid Panel) Pharmaceutical radionuclide perfusion study … AME ACTIONS: Individuals with a negative work-up may be issued the appropriate class of medical certificate with notes in Item 60 and submission of evaluation documents for retention in the file.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
- A note on the table, 1
For a bundle branch block previously documented and evaluated, the protocol says no further evaluation is required unless there is a change in condition. It does not say which part of the protocol applies after a change.
PREVIOUSLY DOCUMENTED AND EVALUATED: No further evaluation required unless there is a change in condition.
- A note on the table, 2
The protocol's AME ACTIONS say that if areas of ischemia are noted, a coronary angiogram will usually be indicated for definitive diagnosis, and that if significant CAD is diagnosed, to refer to Special Issuance guidelines. It does not name the guidelines.
If areas of ischemia are noted, a coronary angiogram will usually be indicated for definitive diagnosis. If significant CAD is diagnosed, refer to Special Issuance guidelines.
- A note on the table, 3
The Item 36 Arrhythmias page's row for bundle branch block, left and right, names IRBBB or ICVD beside a link to a PDF, says to see the protocol, and says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The linked PDF is not one of the documents this page is written from.
Bundle Branch Block (Left and Right) * IRBBB or ICVD ( PDF ) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
The FAA pathways for bundle branch block (BBB)
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: If it was previously documented and evaluated
What the protocol says when there is no change in condition.The protocol says no further evaluation is required unless there is a change in condition.
Show the FAA's words: If it was previously documented and evaluated
PREVIOUSLY DOCUMENTED AND EVALUATED: No further evaluation required unless there is a change in condition.
FAA source: Bundle Branch Block (BBB). FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 2: Complete RBBB at 35 or younger: what the examiner does
Usually no Cardiovascular Evaluation, and an annotation in Block 60.If otherwise healthy, a complete RBBB identified at age 35 or younger will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication.
At the exam
- Your AME annotates Block 60
Show the FAA's words: Complete RBBB at 35 or younger: what the examiner does
RIGHT (RBBB): If a complete RBBB is identified at:
Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication).
FAA source: Bundle Branch Block (BBB). FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). Annotate Block 60.
FAA source: Bundle Branch Block (BBB). FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 3: What the Item 36 page says
The FAA's Arrhythmias page, which points to the protocol.The FAA's Arrhythmias page says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision.
Show the FAA's words: What the Item 36 page says
Bundle Branch Block (Left and Right)
All
See Protocol for Bundle Branch Block (BBB)
If no evidence of structural, functional or coronary heart disease - Issue
Otherwise - Requires FAA Decision
FAA source: Item 36 – Arrhythmias. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
Step 4: See your AME
The protocol says that if otherwise healthy, it will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication, and the examiner annotates Block 60. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.Exam day- The protocol says that if otherwise healthy, it will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication, and the examiner annotates Block 60. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
Show the FAA's words: See your AME
RIGHT (RBBB): If a complete RBBB is identified at:
Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). Annotate Block 60.
FAA source: Bundle Branch Block (BBB). FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Bundle Branch Block (Left and Right)
All
See Protocol for Bundle Branch Block (BBB)
If no evidence of structural, functional or coronary heart disease - Issue
Otherwise - Requires FAA Decision
FAA source: Item 36 – Arrhythmias. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
If significant CAD is diagnosed, refer to Special Issuance guidelines.
FAA source: Bundle Branch Block (BBB). FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Complete RBBB, age 35 or youngerExaminer issuesExaminer can issue
The protocol says that if otherwise healthy, it will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication, and the examiner annotates Block 60. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
Complete RBBB, age 36 or olderExaminer issuesExaminer can issue
The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a stress echo. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
LBBB, any ageExaminer issuesExaminer can issue
The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a pharmaceutical radionuclide perfusion study. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
Show the FAA's words: what the examiner does on each row
- Complete RBBB, age 35 or younger · Examiner can issue
A complete right bundle branch block (RBBB) identified at age 35 or younger. The protocol says that if otherwise healthy, it will usually not require a Cardiovascular Evaluation (CVE), unless there is some other indication, and the examiner annotates Block 60. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
RIGHT (RBBB): If a complete RBBB is identified at: … Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). Annotate Block 60.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
- Complete RBBB, age 36 or older · Examiner can issue
A complete right bundle branch block (RBBB) identified at age 36 or older (or other indication). The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a stress echo. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
RIGHT (RBBB): If a complete RBBB is identified at: … Age 36 or older (or other indication) - Will require a cardiac evaluation to include: CVE ( PDF ) = Narrative + lab (hemoglobin A1C + current Lipid Panel) Stress echo … AME ACTIONS: Individuals with a negative work-up may be issued the appropriate class of medical certificate with notes in Item 60 and submission of evaluation documents for retention in the file.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
- LBBB, any age · Examiner can issue
A left bundle branch block (LBBB) in a person of any age. The protocol requires a cardiac evaluation to include a CVE (a narrative and labs, hemoglobin A1C and a current lipid panel) and a pharmaceutical radionuclide perfusion study. Individuals with a negative work-up may be issued the appropriate class of medical certificate, with notes in Item 60 and the evaluation documents submitted for retention in the file. The ISSUE comes from the Item 36 Arrhythmias page, which says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision. The protocol says that if significant CAD is diagnosed, to refer to Special Issuance guidelines.
LEFT (LBBB): A LBBB in a person of any age will require a cardiac evaluation to include: CVE ( PDF ) = Narrative + lab (hemoglobin A1C + current Lipid Panel) Pharmaceutical radionuclide perfusion study … AME ACTIONS: Individuals with a negative work-up may be issued the appropriate class of medical certificate with notes in Item 60 and submission of evaluation documents for retention in the file.
Bundle Branch Block (Left and Right) … All … See Protocol for Bundle Branch Block (BBB) … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
If significant CAD is diagnosed, refer to Special Issuance guidelines.
Good to know
Points from the FAA's own documents that are easy to miss.
The protocol speaks of a complete RBBB
The protocol's right-sided part is for a complete RBBB. The Item 36 Arrhythmias page's row names IRBBB or ICVD beside a link to a PDF, which is not one of the documents this page is written from.
Show the FAA's words: good to know, 1
RIGHT (RBBB): If a complete RBBB is identified at:
Bundle Branch Block (Left and Right) * IRBBB or ICVD ( PDF )
Another indication moves a younger RBBB
At age 35 or younger, a complete RBBB will usually not require a CVE "unless there is some other indication". The 36-or-older line reads "Age 36 or older (or other indication)" and requires the cardiac evaluation. The protocol does not say what an indication is.
Show the FAA's words: good to know, 2
Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). … Age 36 or older (or other indication) - Will require a cardiac evaluation to include:
The age in the protocol was updated
The protocol's footnote to "Age 35*" reads that the age was updated to 35 (4/2021).
Show the FAA's words: good to know, 3
*Age updated to 35 (4/2021)
A radionuclide test and LBBB
The protocol's note says the exercise radionuclide stress test can often show a false-positive reversible septal defect due to the wall motion abnormality associated with the LBBB, approximately 40% of individuals with LBBB according to the current literature. For a LBBB the cardiac evaluation it lists includes a pharmaceutical radionuclide perfusion study.
Show the FAA's words: good to know, 4
Note: The exercise radionuclide stress test can often show a false-positive reversible septal defect due to the wall motion abnormality associated with the LBBB. Specifically, according to the current literature, approximately 40% of individuals with LBBB will demonstrate a false positive radionuclide reperfusion defect in the septal area. … Pharmaceutical radionuclide perfusion study
Block 60 and Item 60
For a complete RBBB at age 35 or younger the protocol says "Annotate Block 60"; its AME ACTIONS say "notes in Item 60". Both are shown as printed.
Show the FAA's words: good to know, 5
Age 35* or younger - If otherwise healthy, will usually not require a Cardiovascular Evaluation (CVE) (unless there is some other indication). Annotate Block 60. … Individuals with a negative work-up may be issued the appropriate class of medical certificate with notes in Item 60
When the work-up is not negative
The protocol says that if areas of ischemia are noted, a coronary angiogram will usually be indicated, and that significant CAD goes to the Special Issuance guidelines. The Item 36 page says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise Requires FAA Decision.
Show the FAA's words: good to know, 6
If areas of ischemia are noted, a coronary angiogram will usually be indicated for definitive diagnosis. If significant CAD is diagnosed, refer to Special Issuance guidelines.
If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
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.
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.