Left anterior and left posterior hemi-block

Consideration

These ECG abnormalities can be found in 1-2 % of healthy individuals.

If recently acquired, left anterior hemiblock raises the possibility of ischaemia or progressive conduction defect.

The same applies to left posterior hemiblock, though the latter is ten times less frequent and often of little significance.

Information to be provided

On the first occasion that an applicant presents with a left anterior or posterior hemiblock, a cardiologist report to include:

• The result of an echocardiogram;
• A stress ECG if the applicant is aged 45 years old or above, or if required under the General Directions, or as clinically indicated.

On subsequent occasions that an applicant presents with a left anterior or posterior hemiblock:

• Routine investigations as prescribed by the General Directions, provided no change to the ECG has occurred;
• A cardiologist report if a change to the ECG has occurred.

Disposition

On the first occasion that an applicant presents with a left anterior or posterior hemiblock, that applicant may be considered as having a condition that is not of aeromedical significance if:

• No myocardium anatomy abnormality has been identified;
• Ischaemia has been excluded by stress testing if the applicant is 45 years old or above, or if required under the General Directions, or as clinically indicated.

On subsequent occasions that an applicant presents with a left anterior or posterior hemiblock, that applicant may be considered as having a condition that is not of aeromedical significance if:

• The ECG has not changed;
• The applicant’s cardiovascular risk estimate is assessed as being acceptable under the GD.