Waivers for cardiovascular diseases in military aircrew: differences between Japanese and U.S. protocols.

Introduction: Cardiovascular diseases can cause sudden incapacitation in aircrew. Cardiological diagnosis and therapy have changed a great deal in recent decades, as with coronary revascularization, including percutaneous coronary intervention and coronary artery bypass grafting for coronary artery disease, and electrophysiological studies and radiofrequency catheter ablation (RFCA) for sustained arrhythmias. Physicians need to be able to make appropriate, objective recommendations regarding cardiovascular diseases in an aeromedical waiver system.
Methods: We analyzed all 95 waiver cases regarding cardiovascular diseases in the Japan Air Self-Defense Force (JASDF), 1980-2007, and compared them to policies in the United States Air Force (USAF).
Results: The JASDF and the USAF handle most conditions similarly, although there are differences regarding coronary revascularization, atrial fibrillation, non-sustained ventricular tachycardia (nsVT), and hypertrophic cardiomyopathy. The JASDF used RFCA more commonly for the treatment of aircrew with atrial fibrillation and nsVT Although routine follow-up with electrophysiological studies is no longer indicated for Wolff-Parkinson-White and atrioventricular node reentrant tachycardia in USAF policy, the JASDF still conducts reevaluation for all RFCA cases.
Conclusion: This study made recommendations to improve the JASDF waiver system for cardiovascular diseases.