A pacemaker might help people prone to fainting stay on their feet more, according to preliminary research out this week. The findings from this study and others could very well lead to pacemakers becoming the first dedicated treatment for chronic fainting.
Fainting — or syncope, as it’s known medically — is caused when the blood flow to the brain is somehow briefly interrupted. Though there are common triggers for fainting, like stress or simply standing up too fast, it can arrive with no clear underlying cause. Some people are unlucky enough to have recurrent episodes of fainting, which may be tied to chronic conditions like seizure or have no known origin.
Different parts of the body, including the brain, can become dysfunctional enough to lead to an episode of fainting. But it’s most commonly brought on by a sudden drop in blood pressure and slowed heart rate, which is known as vasovagal syncope (referring to the overstimulation of the vagus nerve that runs from the brain to our abdomen). People at risk for recurrent vasovagal syncope can be identified through a tilt test, in which the person lies on a table that tilts up while their blood pressure and heart rate are measured, with the tilt mimicking standing up quickly.
This new research was presented at the European Society Of Cardiology’s annual (and now digital-only) conference. More than 120 people who had had at least two episodes of fainting without warning in the past year and had a response to the tilt test were recruited into a clinical trial. These volunteers were all over the age of 40, had difficulty with their daily life because of their unpredictable fainting, and had no other underlying conditions that could have explained their fainting, such as a history of heart failure or other cardiovascular problems.
They were all outfitted with a pacemaker, a small device implanted in the chest or abdomen that uses electric pulses to keep the heart beating normally if it starts to fluctuate in any way. Half were randomly assigned to have the pacemaker switched on, while the other half had a pacemaker that remained off (the participants didn’t know which group they were in). Then they documented any episodes of fainting over the next year. More than 50% of people in the control group reported at least one bout of fainting during that time, while only 16% in the group with a functional pacemaker reported the same. That amounts to a 77% per cent reduction in the relative risk of fainting, the authors noted, and they estimated that the use of a pacemaker would prevent fainting for roughly every two people with this form of syncope.
The study’s findings are preliminary, since they haven’t gone through the typical peer review process. And being implanted with a pacemaker isn’t a completely risk-free endeavour (in the study, five patients reported minor adverse events, including symptoms of lead exposure). But there are no specific treatments available for recurrent fainting, only general advice for avoiding triggers, and it can be a debilitating condition. This also isn’t the first bit of encouraging evidence suggesting that pacemakers can prevent some kinds of recurrent fainting, including in people with known heart problems, though other research suggests that pacemakers may not be a good fit for all people with this condition.
So if this research holds up, pacemakers could prove to be a valuable treatment option for people who haven’t had much of one in the first place.
“Our study shows that pacing can be an effective treatment for selected people with unpredictable fainting episodes. Tilt testing is a simple and non-invasive way to identify people who could benefit,” said study author Michele Brignole of the Faint and Fall Program at the Istituto Auxologico in Milan, Italy, in a statement released by the European Society Of Cardiology. “We hope this new treatment option will enable these patients to resume a normal life without fear of blackouts.”