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ICAO Preliminary Unedited Version — October 2008 III-App. 1B-15
14. 49-year-old normotensive ATPL-holder who demonstrates sinus rhythm with a heart rate of 60
bpm. There is a non-specific increase in the QRS duration to 110 ms, although part of this is a
contribution from right bundle branch delay, reflected as an S-wave in S1 and V6. There is an Swave
in S1, S2 and S3, but the S1,2,3 pattern is not present. The heart is clockwise rotated about
its longitudinal axis. The pilot was exercised on account of apparent deepening of the S-wave in
SII (consistent with left anterior hemi-block) but the recording was normal. He was made fit
without restriction but with annual follow up to watch for the possibility of progressive evidence
of conduction disturbance.
I
II
III
ICAO Preliminary Unedited Version — October 2008 III-App. 1B-16
15. 28-year-old first officer who demonstrates a sinus bradycardia at a rate of 55 bpm. The recording
is normal apart from the rSr’ in V1. This reflects incomplete right bundle branch aberration. It is a
common normal variant. If significant right axis deviation is present, the possibility of a
secundum atrial septal defect should be considered and an echocardiogram carried out.
ICAO Preliminary Unedited Version — October 2008 III-App. 1B-17
16. 57-year-old training captain who demonstrates complete right bundle branch aberration which had
been present for 24 years. This is evidenced by the deep S-wave in SI and aVL together with V5
and V6. Furthermore there is an rsR complex in V1. The axis is indeterminate but the increasing
depth of the S-waves in SII, SIII and aVF led to exercise electrocardiography which was negative
at 11 minutes of the Bruce protocol. Likewise the echocardiogram and Holter monitoring were
normal. The PR-interval was at the upper limit of normal at 202 ms. The blood pressure was
borderline – 146/84 mm Hg. The medical assessment was restricted to multi-crew operations.
ICAO Preliminary Unedited Version — October 2008 III-App. 1B-18
17. 48-year-old airline captain with complete left bundle branch aberration with a heart rate of
57 bpm. The condition had been stable for eleven years. The axis is left -30º. This pattern is not
completely characteristic as the T-waves would normally be expected to be asymmetrically
inverted in SI, aVL and V5 and V6. The notch on the inscription of the R-wave is characteristic
as is the absence of a septal Q-wave in SI, aVL, V5 and V6. The QRS duration is 140 ms. Poor
R-wave progression in the chest leads is also a feature. He was investigated with exercise
electrocardiography, thallium scanning, echocardiography, and Holter monitoring. All were
reassuringly negative. After three years of follow-up, he was given an unrestricted medical
assessment.
ICAO Preliminary Unedited Version — October 2008 III-App. 1B-19
18. 43-year-old normotensive private pilot who is in sinus rhythm at a heart rate of 69 bpm. He has
significant left axis deviation (-56º) giving rS deflections in SII, SIII and aVF. This reflects left
anterior hemi-block. The broad S-wave in S1, V5 and V6 together with rsS deflection in V1
indicates that complete right bundle branch aberration is also present. The latter was
longstanding but the former was acquired. Exercise electrocardiography was normal at 12
minutes whilst echocardiography and Holter monitoring revealed no abnormality. As an acquired
pattern in an asymptomatic individual, it is likely to be caused by very slowly progressive fine
fibrosis of the conducting tissue (Lenègre’s disease). Coronary artery disease may be present and
this possibility should be investigated. Regular cardiological review with exercise
electrocardiography and Holter monitoring is required. A medical assessment with limitation to
multi-crew operations is recommended.
ICAO Preliminary Unedited Version — October 2008 III-App. 1B-20
19. 49-year-old air traffic controller who demonstrates an rSr complex in V1 and V2 suggestive of
incomplete right bundle branch delay although there is no matching S-wave in the left chest
leads. In this situation, leads V1 and V2 may have been plced in the 2nd rather than the 4th
intercoastal spaces. High take-off of the ST-segment is seen in V4, the small notch on the Swave
reflecting an Osborn-wave. This is a normal variant. The PR interval is short – 114 ms and
there is possibly a delta wave in V4 consistent with a minor degree of pre-excitation. Minor
degrees of pre-excitation are sometimes mistaken for incomplete left bundle branch aberration,
which this may be. He had always been asymptomatic and exercise electrocardiography was
normal. He received an unrestricted medical assessment.
　
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本文鏈接地址：Manual of Civil Aviation Medicine 1(110)