How can a pacemaker help with fainting problems?

Pacemaker on an electrocardiograph

After years of fainting, I've been fitted with a pacemaker. Why might this help?

Professor Richard Sutton says:

Fainting is quite common. The medical term is syncope or transient loss of consciousness. About 40 per cent of people faint at least once in their life, but it’s usually not dangerous.

Common triggers are standing in crowded, stuffy rooms, an unpleasant sight, dehydration, pain, and even coughing or urinating. Any of these can cause the subconscious nervous system, which controls your heart rate and blood pressure, to slow the heart and dilate blood vessels.

Anyone worried about their fainting should see their doctor, who can diagnose or rule out any medical problems

Fainting is much more likely if you are standing, as gravity causes blood to gather in your lower limbs, abdomen and pelvis rather than returning to the heart. This combination of events dramatically reduces your blood pressure, causing loss of consciousness. Once you’ve collapsed to the ground, gravity permits blood to return to the heart, your blood pressure rises, and consciousness is restored.

Anyone worried about their fainting should see their doctor, who can diagnose or rule out any medical problems, such as an abnormal heart rhythm or epilepsy. If necessary, diagnosis may be confirmed by a tilt test, where you’re attached to a special bed that tilts you to a near-standing position while heart rate and blood pressure are measured with an ECG and a finger cuff. Many people can be treated by avoiding situations that trigger their faints or taking measures to raise their blood pressure, such as drinking more fluids and increasing salt intake, or reducing their dose of blood-pressure-lowering medication.

There is also evidence that, if you feel a faint coming on, you can avert it by crossing and tensing your arms and legs, and squeezing your buttocks for 20–30 seconds or more. If you think this might help you, ask your GP or specialist for advice on how to do it effectively.

Before a decision is made to implant a pacemaker, you’d usually have an implantable loop recorder test

A pacemaker is only used if your fainting is regular and significantly reducing your quality of life. This could help if your heart rate slows down so much during a faint that it stops completely. Before a decision is made to implant a pacemaker, you’d usually have an implantable loop recorder test – a small device that measures your heart rate and checks if your heart is stopping during faints.

Recent research has shown that pacemaker treatment is most likely to be successful if the implantable loop recorder shows the heart is stopping, but you don’t faint during the tilt test.

If you did have an implantable loop recorder test first, and it showed your heart stopping, the pacemaker is likely to prevent the majority of your faints in future.

Pacemaker treatment for fainting is fairly rare: a syncope specialist might see a maximum of five patients a year where this could be considered. Most of these patients are aged over 40.

Professor Richard SuttonMeet the expert

Richard Sutton is Emeritus Professor of Clinical Cardiology at the National Heart & Lung Institute, Imperial College London.

 

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