First treatment identified for fainting

Date:
September 1, 2020
Source:
European Society of Cardiology
Summary:
Fainting affects one in two people during their lifetime. Those
with recurrent episodes are often afraid to socialize or go to
work. Today researchers report the first effective therapy.



FULL STORY ========================================================================== Fainting affects one in two people during their lifetime. Those with
recurrent episodes are often afraid to socialise or go to work. Today researchers report the first effective therapy. The late breaking research
is presented at ESC Congress 2020.


========================================================================== Fainting is caused by a fall in blood pressure and/or number of heart
beats. In some patients, a trigger is identified -- for example emotional stress, standing in a hot, crowded space or sitting up too quickly --
and they have warning signs such as weakness, nausea, and dizziness. But
in many others, especially older adults, no trigger is found and there
are no warning signs.

"This unpredictability raises the risk of falls and even serious trauma
and people end up in the emergency room," said principal investigator
Professor Michele Brignole of the Faint and Fall Programme, Istituto Auxologico, Milan, Italy. "If it happens repeatedly, it has a major
impact on quality of life - - at the same magnitude as a chronic disease." Currently there is no specific therapy and patients usually receive only generic advice on prevention, such as keeping hydrated, avoiding hot
crowded environments, tensing the muscles, and lying down. But prevention
is particularly difficult if there are no warning signs.

The BIOSync CLS study examined whether a pacemaker could prevent
unpredictable fainting caused by missed heart beats. Patients with this particular cause of fainting were identified using tilt testing. This
involves lying on a table that is slowly tilted upward to simulate
standing up. Blood pressure and heart rate are monitored during the examination.

The study included 128 patients aged 40 and above who had fainted at
least twice in the previous year with no warning signs. A tilt test
showed that fainting was caused by missed heart beats.

All study participants received a pacemaker -- but they were randomly
allocated to having the pacemaker switched on (pacing group) or switched
off (control group). They were then followed-up for fainting episodes.

During a median follow-up of 11.2 months, more than half of patients
(53%) in the control group fainted compared to just 16% in the pacing
group. This translated into a 77% lower risk of fainting in the pacing
group.

The researchers estimated that at two years, two-thirds (68%) of the
control group would have a fainting episode compared to one-fifth (22%)
of the pacing group. A pacemaker would provide a 77% relative risk
reduction of fainting over two years and a 46% absolute risk reduction.

Just over two patients (2.2) would need to receive a pacemaker to prevent fainting. Put another way, if 11 patients received a pacemaker, fainting
could be avoided in five patients.

Implanting the pacemaker caused minor adverse events in five patients
(4%) such as lead-related complications.

Professor Brignole said: "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.

We hope this new treatment option will enable these patients to resume
a normal life without fear of blackouts."

========================================================================== Story Source: Materials provided by European_Society_of_Cardiology. Note: Content may be edited for style and length.


==========================================================================


Link to news story: https://www.sciencedaily.com/releases/2020/09/200901085256.htm

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