...And the Beats Keep Runnin Runnin (In Space)
Introduction: This case series describes the medical clearance of NASA astronauts after diagnosis of atrial fibrillation seeking to fly to the International Space Station (ISS). BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia with increasing incidence with age and is associated with increased lifetime risk of stroke. Treatment may consist of pharmacologic rate control and anticoagulation. Although it is not yet known how spaceflight modifies risk of cardioembolic event or adverse treatment effects, these can have significant impact on mission and crew health for spaceflight and granting a medical waiver for flight is a complex, case-by-case consideration. Case Presentation: We reviewed all records of waivers granted by NASA for atrial fibrillation and flutter, and identified 6 cases (4 short-duration [<18 days] and 2 long-duration missions [>60 days]) where waiver was granted with subsequent spaceflight. DISCUSSION: NASA has approved astronauts with a history of atrial fibrillation or flutter for flight following an appropriate medical evaluation. With the high prevalence of atrial fibrillation in the general population, we anticipate that consideration of medical waiver will become increasingly common as commercial spaceflight grows. These cases provide a potential framework for risk assessment and management of this population, to balance potential risk modification inherent in the microgravity environment against implications to crew performance, mission success, and personal health of spaceflight participants