Two words describe the FAA’s decision to extend the PR interval on pilot EKGs

…Pretty Risky

Considering that three pilots have died while at work this past week, I feel it is necessary to get this important message out. You can verify the pilot deaths here:

PILOT Death - IndiGo Pilot who was to operate (NAG-PNQ) flight from Nagpur to Pune, India, collapsed at the boarding gate on Aug.17, 2023 and died in hospital - 3rd pilot death this week, 5th collapse

Aviation safety has been significantly degraded by extending the allowable PR interval. This is permitting some pilots to continue to be in command of passenger aircraft when they are in danger of experiencing sudden death due to asymptomatic myocarditis that could be hiding behind an extended PR interval.

This is an electrocardiogram readout strip, abbreviated ECG or EKG.

It basically graphs the electrical depolarization and repolarization of the heart as it is pumping. The PR interval is measured on the strip as the delay time for the blood in the upper chambers of the heart to be pumped into the lower chambers of the heart. The normal delay time is .12 seconds to .2 seconds. There are big boxes and small boxes on an EKG readout that correspond to time. The big box is .2 seconds, so the PR interval normally fits within the big box and is easy to spot if it doesn’t fit. It is true that a longer PR interval from .21 seconds to .3 seconds can be considered a normal variant in some people. Most commonly these longer intervals are seen in young athletes with something called a high vagal tone. High vagal tone is something that can be determined with various testing methods. Longer intervals can also be seen in a few healthy people as they age beyond 40 years.

According to the FAA, their guidance to medical examiners as early as 2016 suggested that extensions of PR intervals in pilots from .21 seconds to .3 seconds could be considered normal if the pilot has no symptoms. This is entirely a judgement call of the examining physician to ascertain an apparent high vagal tone based on the physical fitness and age of the pilot, and believe the report of the pilot that there are no symptoms. If the physician has any suspicions, further testing is to be done. The official Guidance to Aviation Medical Examiners manual (GAME) was updated in October of 2022 to reflect this extended PR interval guidance. Why it took so long to update the manual is a question that has not been answered. When pressed for an answer as to why the manual was updated to accept prolonged intervals as normal variants, one reason given was to save the pilot the time and expense of having to undergo further testing. In fact, the wording in the response to a request as to why the PR interval was extended was: “The FAA also notes that overly stringent requirements for additional workup and testing may not be benign and may expose an applicant to overly burdensome costs and unwarranted hazards.”

It is my opinion that during the time frame of 2016 through 2020, the decision to allow asymptomatic pilots with extended PR intervals to be dismissed as normal variants was probably safe based on no increase in pilot incapacitations. But in 2021, the landscape changed. Pilots were coerced and, in some instances, mandated into getting covid-19 experimental mRNA injections. It is well documented that an adverse reaction to the injection is myocarditis. It is also well known that myocarditis can cause an extension of the PR interval. Also, pilot incapacitations have become more frequent since the rollout of the covid shot.

The problem with this PR interval guidance is that in some cases, myocarditis can be completely asymptomatic. Therefore, the report of the pilot that there are no symptoms is no longer sufficient to put them in the normal variant category. Complicating the issue is the fact that other things can cause an extension of the PR interval such as AV node disease, certain medications such as beta blockers, and electrolyte imbalances, therefore an extended PR interval cannot be a definitive diagnosis for myocarditis. It can only be an indication to investigate further.

Since myocarditis can lead to sudden heart failure, pilots with a confirmed myocarditis diagnosis shall not be issued a medical certificate. Further, since myocarditis is a known adverse reaction to covid shots, and myocarditis is something that can extend the PR interval, it is my opinion that the safe and responsible thing to do is further testing in all pilots that display an extended PR interval and not just assume it is a normal variant. As the FAA mentioned, further testing may be costly and invasive to the pilot, and that is true. However, there are inexpensive blood tests that can be done (including d-dimer and troponin) to determine which pilots would need to undergo further expensive testing. Although individually expensive, the cost will be tremendous if we have the unthinkable but preventable disaster involving multiple lives lost.

What would be helpful is data on exactly how many pilots showed an extended PR interval monthly over the years, pre and post vaccine rollout. This would give us a clue as to whether the covid shot is involved. US Freedom Flyers did a FOIA request asking for that information back in January of 2023. Six months later, the FAA responded and stated they don’t track that data. Here is an image of the response to that FOIA request:

They should be tracking it. They should also be adding the history of mRNA injections into the pilot’s permanent FAA medical records. The recording of mRNA injections into pilots is important because messenger RNA codes to produce proteins in the body that are bioactive, and some injection recipients continue to make these proteins for extended periods. These are not inert proteins like the ones you eat or cells of your body manufacture for various purposes all the time. They are bioactive and will attach to specific receptors on tissue cells, including those that line blood vessel walls and the lining of the heart. The immune system will attack and destroy those cells resulting in all sorts of pathologies including aneurysms, micro hemorrhaging, and myocarditis.

The FAA should immediately prohibit further injections of mRNA into flight crews, and do further cardiac testing on pilots with extended PR intervals.