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IntroductionAtrial fibrillation (AF) is an arrhythmia impacting military occupational performances. Despite being a recognised disqualifying condition, there is no literature describing US military service members with AF. This study aims to describe members with AF diagnoses, the distribution of treatment strategies and associated deployment and retention rates.MethodsActive duty service members identified with AF from 2004 to 2019 were investigated. Cardiovascular profiles, AF management strategies and military dispositions were assessed by electronic medical record review.Results386 service members (mean age 35.0±9.4 years; 94% paroxysmal AF) with AF diagnoses were identified. 91 (24%) had hypertension followed by 75 (19%) with sleep apnoea. Mean CHA2DS2-VASc scores were low (0.39±0.65). Rhythm treatments were used in 173 (45%) followed by rate control strategies in 155 (40%). 161 (42%) underwent pulmonary vein isolation (PVI). In subgroup analysis of 365 personnel, 147 (40%) deployed and 248 (68%) remained active duty after AF diagnosis. Deployment and retention rates did not differ between those who received no medical therapy, rate control or rhythm strategies (p=0.9039 and p=0.6192, respectively). PVI did not significantly impact deployment or retention rates (p=0.3903 and p=0.0929, respectively).ConclusionService members with AF are young with few AF risk factors. Rate and rhythm medical therapies were used evenly. Over two-thirds met retention standards and 40% deployed after diagnosis. There were no differences in deployment or retention between groups who receive rate therapy, rhythm medical therapy or PVI. Prospective evaluation of the efficacy of specific AF therapies on AF burden and symptomatology in service members is needed.

Introduction Atrial fibrillation (AF) is an arrhythmia that impacts deployment and retention rates for United States military pilots. This study aims to characterize United States active duty (AD) pilots with AF and review deployment and retention rates associated with medical and ablative therapies. Methods An observational analysis was performed to assess AD pilots diagnosed with AF in the largest military regional healthcare system from 2004 to 2019. Baseline characteristics and AF management were reviewed. Results 27 AD pilots (mean age, 37.3 ± 7.9 years; mean BMI, 27.3 ± 3.1 kg/m2; 100% male sex) were diagnosed with AF during the study dates. 17 (63%) were Air Force branch pilots with hypertension as the most common risk factor (26%). There were overall low CHA2DS2-VASc scores (mean 0.29 ± 0.47). 22 (82%) pilots were equally treated with medical rate and rhythm strategies (41% and 41%, respectively). 16 (59%) underwent pulmonary vein isolation (PVI) with zero complications. 11 (41%) pilots received warfarin and 5 (19%) received a direct oral anticoagulant for stroke prevention. After diagnosis, 12 (44%) pilots deployed and 25 (93%) were retained in military. PVI was not associated with a change in subsequent deployments rates (PVI, 38% vs no PVI, 55%; p = 0.3809) or retention rates (PVI, 94% vs no PVI, 91%; p = 0.7835). Conclusions United States military pilots diagnosed with AF are younger patients with few traditional AF risk factors and  they receive medical rate and rhythm strategies equally. Many pilots maintain deployment eligibility and most remain on AD status after diagnosis. PVI is not associated with differences in retention or deployment rates. Further prospective study is needed to further evaluate these findings.