Arrhythmia, Bradycardia and Extrasystoles at the Military Board

The short answer: "arrhythmia" is too broad a word to decide anything. Article 42 of the Schedule of Diseases distinguishes specific rhythm and conduction disorders, and the range is vast: from category D for complete atrioventricular block to complete disregard of functional sinus arrhythmia. In between lies a large group where the heart failure functional class decides everything.

Which fitness category rhythm disorders yield

Sinus arrhythmia and persistent disorders: where the class decides

The regulation sets it apart in its own paragraph:

Persons with persistent cardiac rhythm and conduction disturbances lasting more than 7 days, requiring antiarrhythmic therapy or catheter ablation and recurring after treatment ceases, with paroxysmal supraventricular tachyarrhythmias, Wolff-Parkinson-White syndrome, permanent second-degree atrioventricular block without Morgagni-Adams-Stokes syndrome, second-degree sinoatrial block, complete bundle branch blocks, are assessed under clause «a» or «b» depending on the heart failure functional class. In the absence of heart failure or with class I or II, assessment is carried out under clause «v».

So even a complete bundle branch block without heart failure yields category V, not D. And conversely, without an assessment of functional class the clause cannot be determined at all.

What the regulation disregards

The most practically important list in article 42. These are physiological phenomena that "are not grounds for applying this article, do not prevent military service or admission to military educational institutions" — in the absence of clinical manifestations and cardiovascular pathology:

• functional (vagal) first-degree AV block — the kind that normalises on exertion or after atropine;
• incomplete right bundle branch block and non-specific intraventricular conduction disturbances;
• anterior fascicular block (axis deviation beyond minus 30 degrees) or posterior fascicular block of the left bundle;
• additional or anomalously placed chordae of the left ventricle;
• atrial septal aneurysm;
• mitral and tricuspid valve prolapse with first-degree regurgitation without heart failure;
• past non-rheumatic myocarditis without progression to myocardiosclerosis and without rhythm disturbance.

Article 47 adds to that list: rare isolated resting extrasystoles and functional sinus arrhythmia.

Bradycardia and sinus bradycardia: where the line runs

Article 42 has no separate line for bradycardia. A slow rhythm is assessed through its cause: sick sinus syndrome falls under clause «a» with category D, second-degree sinoatrial block joins the group where the functional class decides, and functional bradycardia in a trained person without complaints or structural changes provides no grounds for the article at all.

Records should therefore state not "bradycardia" but its cause and confirmation: Holter monitoring with minimum and mean rates, pauses, and the response to exercise.

Extrasystoles and ventricular disorders: what matters

The same principle applies. Rare isolated resting extrasystoles are excluded by the regulation outright. What counts are ventricular tachyarrhythmias: malignant and potentially malignant ones fall under clause «a» with category D, while idiopathic "benign" ones unassociated with heart disease fall under clause «g» with category B-4. They are separated not by the number of extrasystoles but by the presence of structural heart disease and the nature of the arrhythmia.

What your records must contain

• Holter monitoring — the key document: number and nature of disturbances, pauses, episode durations.
• A resting ECG with mandatory assessment of the PQ interval and a calculated corrected QT.
• Echocardiography with ejection fraction and chamber dimensions — without it the functional class cannot be set.
• An exercise test — bicycle ergometry or treadmill, plus a six-minute walk test.
• Dates and durations of episodes, the therapy prescribed and its outcome.
• The chart code is I48 for atrial fibrillation; how a tracing reads is covered in reading an ECG.

What is usually missing

• There is a single ECG but no Holter — nothing to show persistence with.
• The corrected QT was not calculated, although the regulation requires it outright.
• No echocardiography, so the heart failure functional class is undetermined.
• The conclusion says "arrhythmia" without naming the type of disturbance.
• Organic and autonomic origins are not separated — and the article, 42 or 47, depends on that.
• Non-cardiac causes were not excluded: thyroid, anaemia, deficiencies; what lies behind rapid heartbeat is covered separately.

Questions for your doctor

• Which specific rhythm or conduction disorder is recorded for me?
• What did the Holter show: how many episodes, of what duration, any pauses?
• Which heart failure functional class has been established?
• Are there structural changes on echocardiography?
• Does my finding belong to the list of physiological phenomena in article 42?

Heart rhythm at departmental boards

The above concerns assessment under Government Decree No. 565. The Interior Ministry, National Guard, Federal Security Service and Emergencies Ministry use their own schedules of diseases with their own requirements. A review under articles 42 and 47 shows how complete your records are but is not their regulation.

The short version

The range for rhythm disorders runs from D to complete disregard, and three things fix your place in it: the type of disturbance, the presence of structural heart disease, and the heart failure functional class. Before counting on a category, check whether your finding appears in the explicitly listed physiological phenomena — half of what people bring to the board is there. Only the military medical board determines the fitness category.