Left Bundle Branch Block (LBBB)

Consideration

Left Bundle Branch Block results from ischaemic heart disease in over a quarter of cases. This is particular true for applicants presenting over the age of 45 with a new LBBB. The risk of sudden death in this group is about 10 times that of a control group. A LBBB may manifest as an intermittent rate related phenomenon or be constant.

The discovery of a LBBB requires investigations. Stress ECG alone is unable to exclude ischaemia. Stress echocardiography or myocardial perfusion scan are necessary for that purpose. A stress echocardiography can be difficult to interpret as the LBBB will affect septal motion.

Information to be provided

On the first occasion that an applicant presents with LBBB:

• A cardiologist report and investigations reports to include at least the result of a stress echocardiogram, alternatively a CT Coronary Angiography or stress myocardial perfusion scan (MPI). The applicant should not be exercising their privileges while investigations are carried out.
• Other tests as may be required during the flexibility process.

On subsequent occasions:

• Reports and tests results as recommended by a cardiologist and / or advised by the CAA.

Disposition

An applicant with LBBB must be considered as having a condition that is of aeromedical significance; unless:

• A previous AMC has concluded that the condition may be considered as not being of aeromedical significance.