Kim Jamerson is a healthy 66 year old woman (although this is a true story the patients real name has been changed to protect her privacy).  Kim had always been the picture of health and never really had any medical problems until early 1998 when one day while sitting in a chair she had a sudden passing out spell.  Her husband called 911 and she was taken to Palms West Hospital.  A full work-up was then initiated by her cardiologist Dr. Jean Foucauld.  kim underwent stress testing, echocardiography, a 24 hour EKG recording (called a holter monitor), a head CT scan and an electroencephalogram.  All of these tests were completely normal.  A neurologist called to see Kim could find nothing wrong with her.  Kim was diagnosed with syncope.  This is the medical term for a passing out spell.  Syncope is one of the most common emergency room diagnosis in the state of Florida particularly in people over the age of 60.  Unfortunately, as with many of these patients Kim's initial and thorough evaluation did not point to a cause of her syncope.  She was therefore discharged from the hospital.  Three weeks latter while at a party she again collapsed this time severely bruising her face.  This patient clearly had a problem - but how to get to the root of the problem? Dr. Foucauld referred the patient to Dr. Fishel at Florida Electrophysiology Consultants.

Fainting spells are generally due to one of two causes.  Either a too low blood pressure or an abnormal heart rhythm.  These two causes account for over 90% of all episodes of sudden fainting.  Epilepsy, a blocked artery in the neck and a stroke account for less then 10% of all causes of syncope (i.e. fainting).  Mrs. J. underwent a tilt table test.  This is a test designed to pick up a low blood pressure as a cause of passing out.  This test too was perfectly normal.  Mrs. J. was discharged only to have yet another fainting spell while sitting in a restaurant a month latter.  

In this patients case essentially every cause of fainting except for a heart rhythm problem had been ruled out.  Unfortunately, all of Mrs. Jamerson's episodes occurred when she was outside of the hospital and thus not attached to a heart monitor.  If this patient had been attached to a heart monitor during the spells then one could definitively rule in or rule out a heart rhythm problem as a cause for passing out.  In years past this was impossible and the doctor often had to wait for something really bad to happen to the patient in order to find out the cause of the passing out spells.  

Today the situation is different.  Dr. Fishel recommended Mrs. J. receive a "Reveal" event recorder implant.  This new device is essentially an automatic continuous EKG machine the size of a micro-chip which is implanted under the skin with simple local anesthetic. The device has a two year battery life and can record the patients EKG continuously for two full years.  Should the patient ever have another passing out spell, the device will record the heart rhythm during the spell and hours (or even days) latter a doctor can retrieve the information by holding a radio driven wand over the patient.

A "reveal" Implantable Event recorder

Mrs. J. received her reveal implant and went home latter that day.  Two months passed without incident and then one day she had yet another fainting spell.  This time however she came to see Dr. Fishel in his office.  The reveal was interrogated and the EKGs from three hours earlier were pulled up.  These EKGs showed that during the time that this patient passed out her heart had stopped for a full forty seconds. This type of rhythm problem is called asystole and will cause passing out in everyone.  If it were to have continued, it would cause death.  This particular rhythm problem is unfortunately a relatively frequent cause of sudden passing out spells and it's diagnosis can remain elusive. Many patients are also just like Mrs. J. - with every known medical testing coming up normal. 

In Mrs. J's case however a firm diagnosis was established.  That very day, she was admitted to the hospital and underwent a pacemaker implantation.  A pacemaker will prevent a patients heart from ever stopping (it will not however prevent the heart from racing too fast - for that an ICD is needed). Mrs. Jamerson left the hospital the next day and has never had another passing out spell.  Nor will she - the cause of her problem was isolated and permanently fixed with a pacemaker implantation.  Her pacemaker continues to work well and we expect at least another 8 years of life for this unit prior to it requiring a battery replacement.

A Pacemaker

It has been two years since this patients pacemaker has been placed and she continues to lead an active life.  She is driving again and has a normal life expectancy.  Unless reminded, she is completely unaware that she even has a pacemaker.  She has no restrictions and what she remembers most about the whole incident is not the pacemaker implant surgery (which she regards as a very minor procedure) but the fear she had prior to the pacemaker implant of having yet another syncopal episode.

Mrs. J's story is a very typical one when it comes to cardiac pacing.  Most patients receive at least some immediate subjective benefit from a pacemaker implant. Many patients experiencing significant gains in energy and a new sense of well being.  In other cases, all that's eliminated is symptoms or a slow heart including lightheaded spells and passing out spells.

Click here to read more answers to questions commonly asked by pacemaker patients