Premature atrial contractions (PACs)
What the FAA's documents say about premature atrial contractions (PACs), in plain words, with the FAA's own words one press away.
FAA term: Premature Atrial Contraction (PAC)
Show the FAA's words: which classes the FAA's table covers
Premature Atrial Contraction (PAC) All Classes
Short version
The disposition table has two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ANo symptoms, no treatment and no medication | Examiner issues | Examiner can issue |
| Row BSymptoms, or requiring treatment | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Premature atrial contractions (PACs)
- Row A · Examiner can issue
Current or history of PACs, with no symptoms and not requiring treatment. This includes PACs found incidentally on ECG. If the examiner can determine the pilot has no symptoms, required no treatment, and does not require medication, the table says ISSUE and has the examiner summarize this history in Block 60. It says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns.
A. Asymptomatic, not requiring treatment Current or history of PACs If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication: This includes PACs found incidentally on ECG. Asymptomatic PACs are considered a Normal Variant. No evaluation is required unless symptomatic or AME has concerns. ISSUE Summarize this history in Block 60.
- Row B · Special Issuance
PACs that cause symptoms, or that require treatment. The table lists what the pilot should submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings, such as test abnormalities or symptoms, in Block 60.
B. Symptomatic OR Requiring treatment The pilot should submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings such as test abnormalities or symptoms) in Block 60.
- A note on the table, 1
The Item 36 Arrhythmias page has its own row for PACs, 2 or more on ECG, for all classes, which says to see the PAC Disposition Table. Its evaluation data reads requires evaluation, e.g., check for MVP, caffeine, pulmonary disease, thyroid, etc. It says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise that an FAA decision is required.
PAC (2 or more on ECG) See PAC Disposition Table ( PDF ) … All … Requires evaluation, e.g., check for MVP, caffeine, pulmonary disease, thyroid, etc. … If no evidence of structural, functional or coronary heart disease - Issue … Otherwise - Requires FAA Decision
The FAA pathways for premature atrial contractions (PACs)
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: What the table says the examiner looks at
For row A, what the examiner determines at the exam.For row A, your AME determines whether you have no symptoms, required no treatment, and do not require medication.
At the exam
- No symptoms
- Required no treatment
- Does not require medication
- Your AME summarizes this history in Block 60
Show the FAA's words: What the table says the examiner looks at
If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication: This includes PACs found incidentally on ECG.
ISSUE
FAA source: Premature Atrial Contractions. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
ISSUE Summarize this history in Block 60.
FAA source: Premature Atrial Contractions. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner can determine the pilot has no symptoms, required no treatment, and does not require medication, the table says ISSUE and has the examiner summarize this history in Block 60. It says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns.Exam day- If the examiner can determine the pilot has no symptoms, required no treatment, and does not require medication, the table says ISSUE and has the examiner summarize this history in Block 60. It says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns.
Show the FAA's words: See your AME
A. Asymptomatic, not requiring treatment Current or history of PACs If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication: This includes PACs found incidentally on ECG. Asymptomatic PACs are considered a Normal Variant. No evaluation is required unless symptomatic or AME has concerns. ISSUE Summarize this history in Block 60.
FAA source: Premature Atrial Contractions. FAA date 27 April 2022; 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 can determine the pilot has no symptoms, required no treatment, and does not require medication, the table says ISSUE and has the examiner summarize this history in Block 60. It says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns.
Row BDefers to the FAASpecial Issuance
The table lists what the pilot should submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings, such as test abnormalities or symptoms, in Block 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Current or history of PACs, with no symptoms and not requiring treatment. This includes PACs found incidentally on ECG. If the examiner can determine the pilot has no symptoms, required no treatment, and does not require medication, the table says ISSUE and has the examiner summarize this history in Block 60. It says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns.
A. Asymptomatic, not requiring treatment Current or history of PACs If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication: This includes PACs found incidentally on ECG. Asymptomatic PACs are considered a Normal Variant. No evaluation is required unless symptomatic or AME has concerns. ISSUE Summarize this history in Block 60.
- Row B · Special Issuance
PACs that cause symptoms, or that require treatment. The table lists what the pilot should submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings, such as test abnormalities or symptoms, in Block 60.
B. Symptomatic OR Requiring treatment The pilot should submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings such as test abnormalities or symptoms) in Block 60.
If the examiner defersSpecial Issuance
The table marks row B, PACs with symptoms or requiring treatment, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating physician or cardiologist no more than 90 days before the exam, with what the table says it should include.
- Item 2. An ECG performed within the past 90 days, or the most recent one (already performed).
- Item 3. A 24-hour cardiac ambulatory monitor (CAM), such as a Holter.
- Item 4. An echocardiogram (echo).
- Item 5. Any other testing deemed necessary by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks row B, PACs with symptoms or requiring treatment, DEFER.
B. Symptomatic OR Requiring treatment … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A current, detailed clinical progress note from a clinic visit with the treating physician or cardiologist no more than 90 days before the exam, with what the table says it should include.
A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or cardiologist no more than 90 days before the AME exam. It should include
- Item 2
An ECG performed within the past 90 days, or the most recent one (already performed).
ECG performed within the past 90 days or most recent (already performed).
- Item 3
A 24-hour cardiac ambulatory monitor (CAM), such as a Holter.
24-hour cardiac ambulatory monitor (CAM) such as holter.
- Item 4
An echocardiogram (echo).
Echocardiogram (echo).
- Item 5
Any other testing deemed necessary by the treating physician.
Any other testing deemed necessary by the treating physician.
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 workGood 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.
PACs found on an ECG by chance
Row A includes PACs found incidentally on ECG. The table marks it ISSUE where the examiner can determine the pilot has no symptoms, required no treatment, and does not require medication.
Show the FAA's words: good to know, 2
If the AME can determine the pilot has no symptoms, required no treatment, and does not require medication: This includes PACs found incidentally on ECG. … ISSUE Summarize this history in Block 60.
Two FAA documents differ on an evaluation
The PAC table says asymptomatic PACs are considered a normal variant, and no evaluation is required unless symptomatic or the examiner has concerns. The Item 36 Arrhythmias page's row for PACs, 2 or more on ECG, says requires evaluation, and names, for example, checks for MVP, caffeine, pulmonary disease and thyroid. It says Issue if there is no evidence of structural, functional or coronary heart disease, and otherwise requires FAA decision. Each is shown as published.
Show the FAA's words: good to know, 3
Asymptomatic PACs are considered a Normal Variant. No evaluation is required unless symptomatic or AME has concerns.
PAC (2 or more on ECG) See PAC Disposition Table ( PDF ) … All … Requires evaluation, e.g., check for MVP, caffeine, pulmonary disease, thyroid, etc. … 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.
- Premature Atrial ContractionsOpen to print: Premature Atrial Contractions, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- 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.