Air Travel and Cardiovascular Disease.

The number of air travelers with cardiac disease will continue to increase. Advances in pacemaker, automatic implantable cardioverter defibrillator (AICD) and revascularization will allow many who could not travel only a few decades ago to do so with relative ease. This growing population will face a variety of hazards related to air travel, including in-flight ischemia, arrhythmia, and venous thromboembolic events. Although there is a dearth of research specifically examining the air traveler with cardiac disease, we have attempted to provide a set of guidelines based on available evidence and basic pathophysiology. These guidelines should not substitute for cardiologic consultation when warranted. Future research is needed to further asses the risk of air travel after myocardial infarction in the age of more complete revascularization and more aggressive antiplatelet therapy. None of the trials cited discuss the use of glycoprotein IIb/IIIa inhibitors, clopidogrel, or drug-coated stents. American Medical Association guidelines on this topic may require revision based on these advances. The current generation of pacemakers and implantable cardioverter defibrillators would allow easy access to data regarding in-flight arrhythmia and might help to further elucidate the impact of altitude on the occurrence of ventricular and atrial arrhythmias.