Implantable Device Solves Mystery of Fainting Spells for Strong Memorial Patient

December 06, 1999

Stephen Candileri began experiencing fainting spells about two years ago and doctors couldn't explain why. The Gates resident passed out without warning at home, on the job as an ATM field technician, and once just moments after pulling over into a parking lot while driving.

Extensive testing was performed over the course of more than a year, from neurological work-ups, to cardiac assessments such as electrocardiograms (ECG), which measured the 52-year-old's heart rhythm, to an external ECG monitor device that could only be worn for a few weeks at a time. Because the fainting spells were infrequent and unpredictable, multiple recordings were unsuccessful in capturing his episodes.

In June, Strong Memorial Hospital cardiologist David Huang, M.D., suggested the use of a device that is implanted under the skin to monitor cardiac rhythms for up to 14 months. For Candileri, this proved to be the solution in finding the cause of his frightening fainting spells.

Approved last year, the Reveal Insertable Loop Recorder is about two and a half inches long, less than three-fourths of an inch wide and a quarter of an inch thick. Implanted under local anesthesia, it is placed in the chest to capture an ECG recording at the time when a patient experiences symptoms.

The electrodes that sense the heart's activity are a part of the device, so no electrical wires inside or outside the body are necessary. Patients can bathe, swim and engage in other activities that may be difficult or impossible while wearing an external monitoring device. The recorder continuously monitors the heart's electrical activity, recording in a "loop" like an ATM camera, replacing old ECG information with new ECG information until the patient has an episode.

When symptoms such as dizziness or fainting occur, the patient places an external, pager-size activator over the area in which the recorder is implanted, then presses a button. This triggers the device to save the ECG information recorded during symptoms and immediately after, so that data can be retrieved by a physician. The device can be programmed to record and store up to 42 minutes of data in several combinations of duration and number of episodes.

After wearing the Reveal recorder through several fainting episodes, Candileri was diagnosed with atrial fibrillation, or an irregular rhythm originating from the upper chambers of the heart. In this condition, a patient's heart rate control can be erratic, either going too fast or too slow at different times. The Reveal device recorded on several occasions that Candileri's heart rate raced up to and remained above 200 beats per minute during his symptomatic episodes.

Because various medications used to slow Candileri's heart rate were unsuccessful, Huang and the referring cardiologist, Jerry Miller, M.D., decided on a procedure to disconnect the electrical communication between the upper and lower chambers of Candileri's heart. This procedure permanently prevented any further episodes of fast heart rhythm originating from the upper chambers to reach the lower chambers, which are the main pumping chambers of heart. A pacemaker also was implanted to regulate his rhythm.

It is estimated that as many as one million people are evaluated and treated for fainting each year in the U.S., at a cost to the healthcare system of more than $1 billion. It also is estimated that 40 percent of patients suffering from a heart rhythm problem who have undergone standard conventional diagnostic testing do not receive a definitive diagnosis. Without a diagnosis for the fainting, potentially curative or life-saving therapy cannot be initiated. The Reveal implantable device is a significant addition that aids physicians in evaluating patients with recurrent fainting or lightheaded spells due to suspected heart rhythm problems.

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Karin Christensen
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