Pacemaker
What the FAA's documents say about pacemaker, in plain words, with the FAA's own words one press away.
FAA term: Pacemaker (Implanted Pacemaker)Covers: All classes
Short version
The Pacemaker disposition table has four rows, for all classes.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AA pacemaker only | Defers to the FAA | Special Issuance |
| Row BA pacemaker with an implantable cardiac defibrillator (ICD) | Defers to the FAA | Special Issuance |
| Row CA pacemaker lead replacement | Defers to the FAA | Special Issuance |
| Row DA pacemaker battery or generator replacement | Examiner issues | Examiner can issue |
Show the FAA's words: the FAA's table for Pacemaker
- Row A · Special Issuance
A pacemaker only, for an initial FAA review. After a 2-month recovery period, the table says to submit the items on the Pacemaker Protocol and the Pacemaker Status Summary to the FAA for review, and its note says all testing must be performed after the 2-month recovery period. The examiner defers and submits the information to the FAA for a possible Special Issuance; 1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or Consultant. Follow-up issuance will be per the airman's authorization letter.
A. Pacemaker Only* Initial FAA review After a 2-month recovery period, Submit the following to the FAA for review. Items on Pacemaker Protocol Pacemaker Status Summary NOTE: All testing must be performed AFTER The 2-month recovery period. DEFER Submit the information to the FAA for a possible Special Issuance. 1 st and 2 nd class airmen are reviewed by the FAS Cardiology Panel or Consultant Follow up Issuance Will be per the airman’s authorization letter.
Protocol for Initial Evaluation of Implanted Pacemaker A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the 2-month recovery period, submit the following:
- Row B · Special Issuance
A pacemaker with an implantable cardiac defibrillator (ICD). The table says an active ICD is disqualifying for all classes, and a pacemaker with an ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned off (i.e., deactivated). The table lists what to submit. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
B. Pacemaker with Implantable Cardiac Defibrillator (ICD)* An active ICD is disqualifying for all classes. Pacemaker with ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned OFF (i.e., deactivated). … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the airman’s authorization letter
- Row C · Special Issuance
A pacemaker lead replacement. After a 2-month recovery period (to ensure lead stability), the table lists what to submit to the FAA for review. Its note says that in accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should not fly, and that once the information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
C. Pacemaker Lead replacement After a 2-month recovery period (to ensure lead stability), submit the following to the FAA for review: … Note: In accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should NOT fly. Once the above information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the airman’s authorization letter.
- Row D · Examiner can issue
A pacemaker battery or generator replacement. After a 14-day recovery period, if the cardiologist OR AME verifies the pocket is healing well, off pain medications, and no complications, the table lists what to submit to the FAA for retention in the file, says ISSUE, and has the examiner annotate Block 60. Its note says that in accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria should not fly.
D. Pacemaker Battery/Generator Replacement After a 14-day recovery period, if the cardiologist OR AME verifies: • The pocket is healing well; • Off pain medications; and • No complications: Submit the following to the FAA for retention in the file: … Note: In accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria, should NOT fly. ISSUE Annotate Block 60 Submit the information to the FAA for retention in your file.
- A note on the table, 1
The Item 36 Arrhythmias page's row for a history of implanted pacemakers, for all classes, says to see the Pacemaker Disposition Table, and says Requires FAA Decision. The table's Row D says ISSUE.
History of Implanted Pacemakers … All … See Pacemaker Disposition Table ( PDF ) … Requires FAA Decision
- A note on the table, 2
For Rows A, B and C the table says follow-up issuance will be per the airman's authorization letter.
Follow up Issuance Will be per the airman’s authorization letter.
The FAA pathways for pacemaker
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: Row A: the recovery period
Two months after the pacemaker is implanted, before the testing.The protocol says a 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization.
Show the FAA's words: Row A: the recovery period
A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the 2-month recovery period, submit the following:
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
After a 2-month recovery period, Submit the following to the FAA for review.
NOTE: All testing must be performed AFTER The 2-month recovery period.
FAA source: Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 2: Row A: records and the cardiology narrative
The items on the protocol, with the Pacemaker Status Summary.Hospital records
Copies of hospital admission summary medical records pertaining to the pacemaker.
This includes
- History and physical
- Operative report
- Discharge summary
- Coronary catheterization or ischemia work up (if performed)
- All ECG tracings
The pacemaker information
- The make of the generator and leads, model, and serial number
Cardiology narrative
A typed narrative or clinical note from your cardiologist detailing your interim and current cardiac condition, functional capacity, medical history, and medications.
It must also include
- Evaluation of pacemaker function
- Programmed pacemaker parameters
- Exclusion of myopotential inhibition and pacemaker induced hypotension (pacemaker syndrome)
- Elective replacement indicator/end of life (ERI/EOL)
- Battery voltage
Pacemaker Status Summary
The Pacemaker Status Summary.
Labs
A hemoglobin A1C and a current blood lipid profile.
The lipid profile, to include
- Total cholesterol
- HDL
- LDL
- Triglycerides
Show the FAA's words: Row A: records and the cardiology narrative
Hospital records . Copies of hospital admission summary medical records pertaining to pacemaker. This includes history and physical, operative report, discharge summary, coronary catheterization or ischemia work up (if performed), and all ECG tracings. Pacemaker information must include the make of the generator and leads, model, and serial number.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Cardiology narrative . A typed narrative or clinical note from your cardiologist detailing your interim and current cardiac condition, functional capacity, medical history, and medications. It must also include: Evaluation of pacemaker function , programmed pacemaker parameters, exclusion of myopotential inhibition and pacemaker induced hypotension (pacemaker syndrome), elective replacement indicator/end of life (ERI/EOL), and battery voltage.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
It must also include:
Pacemaker Status Summary * ( PDF )
* Note: The Pacemaker Status Summary ( PDF ) is not required, however, it will help to streamline and significantly DECREASE FAA review time.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Submit the following to the FAA for review. Items on Pacemaker Protocol Pacemaker Status Summary
FAA source: Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Lab . Hemoglobin A1C and current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 3: Row A: heart tests
The cardiac monitor, the echo and the stress test.Cardiac monitor, at least 24 consecutive hours
A current Holter monitor or similar evaluation for at least 24-consecutive hours, to include select representative tracings.
It must list
- Atrial and ventricular ectopic counts/burden
- Hourly tabular data, with the longest pause duration and counts of all pauses >2.0 or 2.5 seconds
- Heart rate (max and min), other day-by-day histograms, and frequency graphs
- Percentage of time in atrial fibrillation/flutter
Echocardiogram
A current M-mode, 2-dimensional echocardiogram with Doppler.
Maximal graded exercise stress test (GXT)
A current maximal graded exercise stress test (GXT).
If performed
- Images and reports of a radionuclide stress (RS) or cardiac angiogram (cardiac catheterization)
- Not: Xeroxed or faxed images, which will not be accepted due to poor image quality
Show the FAA's words: Row A: heart tests
Cardiac monitor . A current Holter monitor or similar evaluation for at least 24-consecutive hours to include select representative tracings. It must list: Atrial and ventricular ectopic counts/burden; Hourly tabular data to include the longest pause duration and counts of all pauses >2.0 or 2.5 seconds; Heart rate (max and min), other day-by-day histograms, and frequency graphs; and Percentage of time in atrial fibrillation/flutter
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Echo . A current M-mode, 2-dimensional echocardiogram with Doppler.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Stress test . A current Maximal Graded Exercise Stress Test Requirements (GXT). If a radionuclide stress (RS) or cardiac angiogram (cardiac catheterization) were performed, submit those images and reports. Due to poor image quality, Xeroxed or faxed images will not be accepted.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 4: Row A: sending it to the FAA
Your full name and date of birth, and one mailing.The protocol says to send all information in one mailing, and that it is critical the airman's full name and date of birth appear all correspondence and reports (as printed).
Show the FAA's words: Row A: sending it to the FAA
It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification.
To aid in the review process, it is critical that the airman's full name and date of birth appear all correspondence and reports. Send all information in one mailing to:
Mailing Addresses
Using regular mail (US Postal Service)
Using special mail (FedEx, UPS, etc.
FAA source: Implanted Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 5: Two Medtronic pacemakers
The table's notes on the EnRhythm and the REVO.If the pacemaker is a Medtronic REVO.
If the pacemaker is a Medtronic REVO.
For the Medtronic REVO pacemaker, estimated battery longevity, which the table says is required for recertification.
Show the FAA's words: Two Medtronic pacemakers
Medtronic REVO pacemaker requires specific battery information from the manufacturer. Estimated battery longevity is required for recertification and we cannot issue without this specific piece of information. Please note that battery voltage and/or RRT, ERI, or EOL flags are not acceptable substitutes. With the Medtronic REVO pacemaker, the pacer clinic will need to call Medtronic at 1-800-505-4636 with a current scan in order to determine battery longevity.
FAA source: Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Medtronic EnRhythm® Pacemaker is not acceptable for medical certification.
FAA source: Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 6: What the Item 36 page says
The FAA's Arrhythmias page, which points to the table.The FAA's Arrhythmias page says Requires FAA Decision for a history of implanted pacemakers, and points to the table.
Show the FAA's words: What the Item 36 page says
History of Implanted Pacemakers
All
See Pacemaker Disposition Table ( PDF )
Requires FAA Decision
FAA source: Item 36 – Arrhythmias. FAA date 27 March 2024; checked by Crosscheck 14 October 2026.
Step 7: See your AME
After a 2-month recovery period, the table says to submit the items on the Pacemaker Protocol and the Pacemaker Status Summary to the FAA for review, and its note says all testing must be performed after the 2-month recovery period. The examiner defers and submits the information to the FAA for a possible Special Issuance; 1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or Consultant. Follow-up issuance will be per the airman's authorization letter.Exam day- After a 2-month recovery period, the table says to submit the items on the Pacemaker Protocol and the Pacemaker Status Summary to the FAA for review, and its note says all testing must be performed after the 2-month recovery period. The examiner defers and submits the information to the FAA for a possible Special Issuance; 1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or Consultant. Follow-up issuance will be per the airman's authorization letter.
Show the FAA's words: See your AME
A. Pacemaker Only* Initial FAA review After a 2-month recovery period, Submit the following to the FAA for review. Items on Pacemaker Protocol Pacemaker Status Summary NOTE: All testing must be performed AFTER The 2-month recovery period. DEFER Submit the information to the FAA for a possible Special Issuance. 1 st and 2 nd class airmen are reviewed by the FAS Cardiology Panel or Consultant Follow up Issuance Will be per the airman’s authorization letter.
FAA source: Pacemaker. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Protocol for Initial Evaluation of Implanted Pacemaker A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the 2-month recovery period, submit the following:
FAA source: Implanted Pacemaker. 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.
Row ADefers to the FAASpecial Issuance
After a 2-month recovery period, the table says to submit the items on the Pacemaker Protocol and the Pacemaker Status Summary to the FAA for review, and its note says all testing must be performed after the 2-month recovery period. The examiner defers and submits the information to the FAA for a possible Special Issuance; 1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or Consultant. Follow-up issuance will be per the airman's authorization letter.
If the examiner defersRow BDefers to the FAASpecial Issuance
The table lists what to submit. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
If the examiner defersRow CDefers to the FAASpecial Issuance
After a 2-month recovery period (to ensure lead stability), the table lists what to submit to the FAA for review. Its note says that in accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should not fly, and that once the information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
If the examiner defersRow DExaminer issuesExaminer can issue
After a 14-day recovery period, if the cardiologist OR AME verifies the pocket is healing well, off pain medications, and no complications, the table lists what to submit to the FAA for retention in the file, says ISSUE, and has the examiner annotate Block 60. Its note says that in accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria should not fly.
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
A pacemaker only, for an initial FAA review. After a 2-month recovery period, the table says to submit the items on the Pacemaker Protocol and the Pacemaker Status Summary to the FAA for review, and its note says all testing must be performed after the 2-month recovery period. The examiner defers and submits the information to the FAA for a possible Special Issuance; 1st and 2nd class airmen are reviewed by the FAS Cardiology Panel or Consultant. Follow-up issuance will be per the airman's authorization letter.
A. Pacemaker Only* Initial FAA review After a 2-month recovery period, Submit the following to the FAA for review. Items on Pacemaker Protocol Pacemaker Status Summary NOTE: All testing must be performed AFTER The 2-month recovery period. DEFER Submit the information to the FAA for a possible Special Issuance. 1 st and 2 nd class airmen are reviewed by the FAS Cardiology Panel or Consultant Follow up Issuance Will be per the airman’s authorization letter.
Protocol for Initial Evaluation of Implanted Pacemaker A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the 2-month recovery period, submit the following:
- Row B · Special Issuance
A pacemaker with an implantable cardiac defibrillator (ICD). The table says an active ICD is disqualifying for all classes, and a pacemaker with an ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned off (i.e., deactivated). The table lists what to submit. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
B. Pacemaker with Implantable Cardiac Defibrillator (ICD)* An active ICD is disqualifying for all classes. Pacemaker with ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned OFF (i.e., deactivated). … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the airman’s authorization letter
- Row C · Special Issuance
A pacemaker lead replacement. After a 2-month recovery period (to ensure lead stability), the table lists what to submit to the FAA for review. Its note says that in accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should not fly, and that once the information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. The examiner defers and submits the information to the FAA for a possible Special Issuance. Follow-up issuance will be per the airman's authorization letter.
C. Pacemaker Lead replacement After a 2-month recovery period (to ensure lead stability), submit the following to the FAA for review: … Note: In accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should NOT fly. Once the above information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the airman’s authorization letter.
- Row D · Examiner can issue
A pacemaker battery or generator replacement. After a 14-day recovery period, if the cardiologist OR AME verifies the pocket is healing well, off pain medications, and no complications, the table lists what to submit to the FAA for retention in the file, says ISSUE, and has the examiner annotate Block 60. Its note says that in accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria should not fly.
D. Pacemaker Battery/Generator Replacement After a 14-day recovery period, if the cardiologist OR AME verifies: • The pocket is healing well; • Off pain medications; and • No complications: Submit the following to the FAA for retention in the file: … Note: In accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria, should NOT fly. ISSUE Annotate Block 60 Submit the information to the FAA for retention in your file.
If the examiner defersSpecial Issuance
The table marks Row A, a pacemaker only, DEFER.
The table marks Row B, a pacemaker with an implantable cardiac defibrillator (ICD), DEFER.
The table marks Row C, a pacemaker lead replacement, DEFER.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row A, a pacemaker only, DEFER.
A. Pacemaker Only* Initial FAA review … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 2
The table marks Row B, a pacemaker with an implantable cardiac defibrillator (ICD), DEFER.
B. Pacemaker with Implantable Cardiac Defibrillator (ICD)* … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 3
The table marks Row C, a pacemaker lead replacement, DEFER.
C. Pacemaker Lead replacement … DEFER Submit the information to the FAA for a possible Special Issuance.
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 exams
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
PACEMAKER All Classes
For Rows A, B and C the table says follow-up issuance will be per the airman's authorization letter.
Show the FAA's words: at later exams
Follow up Issuance Will be per the airman’s authorization letter.
Follow-up issuance per the authorization letter
For Rows A, B and C the table says follow-up issuance will be per the airman's authorization letter.
Show the FAA's words: Follow-up issuance per the authorization letter
Follow up Issuance Will be per the airman’s authorization letter.
Good to know
Points from the FAA's own documents that are easy to miss.
Is the Pacemaker Status Summary required
On the protocol's page the Pacemaker Status Summary is listed under the cardiology narrative's "It must also include", and the protocol's footnote says it is not required, however, it will help to streamline and significantly decrease FAA review time. The table's Row A lists it among what to submit, and Rows C and D list it as a numbered item. Each is shown as published.
Show the FAA's words: good to know, 1
It must also include: … Pacemaker Status Summary * ( PDF ) … * Note: The Pacemaker Status Summary ( PDF ) is not required, however, it will help to streamline and significantly DECREASE FAA review time.
Submit the following to the FAA for review. Items on Pacemaker Protocol Pacemaker Status Summary … 1. Procedure note detailing the replacement 2. Pacemaker Status Summary
The Item 36 page and Row D
The Item 36 Arrhythmias page says Requires FAA Decision for a history of implanted pacemakers, and points to the table. The table's Row D, a battery or generator replacement, says ISSUE. Both are shown as published.
Show the FAA's words: good to know, 2
History of Implanted Pacemakers … All … See Pacemaker Disposition Table ( PDF ) … Requires FAA Decision
D. Pacemaker Battery/Generator Replacement … ISSUE Annotate Block 60 Submit the information to the FAA for retention in your file.
An active ICD is disqualifying
The table says an active ICD is disqualifying for all classes, and a pacemaker with an ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned off (i.e., deactivated).
Show the FAA's words: good to know, 3
An active ICD is disqualifying for all classes. Pacemaker with ICD will be considered only with documentation from the treating cardiologist that the ICD circuit has been turned OFF (i.e., deactivated).
Not flying after a lead or battery replacement
After a lead replacement, the table's note says airmen who currently hold a medical certificate should not fly until the information is submitted and the FAA authorizes the Special Issuance. After a battery or generator replacement, it says pilots who currently hold a medical certificate and have not yet met the row's criteria should not fly. Both notes cite CFR61.53.
Show the FAA's words: good to know, 4
Note: In accordance with CFR61.53, airmen who currently hold a medical certificate and have a lead replaced should NOT fly. Once the above information is submitted and if the FAA authorizes the Special Issuance, the airman may resume flight duties. … Note: In accordance with CFR61.53, pilots who currently hold a medical certificate and have not yet met the above criteria, should NOT fly.
Two Medtronic pacemakers
The table's notes say the Medtronic EnRhythm Pacemaker is not acceptable for medical certification, and that for the Medtronic REVO pacemaker, estimated battery longevity is required for recertification, with battery voltage and/or RRT, ERI, or EOL flags not acceptable substitutes. The protocol's cardiology narrative includes battery voltage and ERI/EOL; both are shown as published.
Show the FAA's words: good to know, 5
Medtronic EnRhythm® Pacemaker is not acceptable for medical certification. … Estimated battery longevity is required for recertification and we cannot issue without this specific piece of information. Please note that battery voltage and/or RRT, ERI, or EOL flags are not acceptable substitutes.
elective replacement indicator/end of life (ERI/EOL), and battery voltage.
The protocol's two pause thresholds
The protocol's cardiac monitor counts all pauses ">2.0 or 2.5 seconds" and does not say which threshold applies. This page shows the line as printed.
Show the FAA's words: good to know, 6
Hourly tabular data to include the longest pause duration and counts of all pauses >2.0 or 2.5 seconds;
Pacemaker dependency evaluation is no longer required
The protocol's note says evaluation of pacemaker dependency is no longer required for any class as of 08/25/2021.
Show the FAA's words: good to know, 7
Note: Evaluation of Pacemaker Dependency is no longer required for any class as of 08/25/2021
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.