Fainting is an indication of something gone awry. It could be minor or it could be serious, even life-threatening. For centuries there was no way to know, until it was too late.
Today we know that unexplained fainting, especially in older people, is often caused by irregular heartbeat, also known as arrhythmia. Once a physician has eliminated other possible causes, a heart monitoring procedure is employed, in order to “look at” the heart rhythm, make a diagnosis and provide the proper treatment.
According to Dr. Howard Tee, board-certified in Internal Medicine and Cardiology, before a diagnosis of irregular heartbeat is made and a heart monitor recommended, other possible causes of unexplained fainting are eliminated. These can include: blood pressure issues; stroke; carotid artery disease; seizures; reaction to medication; even what, in the medical community, is common enough to be referred to as “white coat hypertension” (a strong physical reaction upon meeting a physician.)
Dr. Tee performs heart monitoring procedures at the Sebastian River Medical Center Cath Lab as well as at the Heart Center of the Treasure Coast in Vero Beach. Dr. Tee, joined by Rick Walters, Director of Cardiovascular Services at SRMC, talked about the most current heart monitoring technology and how it has advanced from the much larger, more uncomfortable and less efficient monitors commonly used in previous years.
In 1949, physicist Norman J. Holter invented telemetric cardiac monitoring, and clinical use started in the early 1960s. A portable device named after Holter was used “in the old days” to continuously monitor electrical activity in the cardiovascular system, to detect heart rhythm abnormalities (arrhythmia.)
With a Holter monitor, between three and eight electrodes were placed strategically on the patient’s chest, and connected to a small piece of equipment attached to the patient’s belt or hung around the neck, which kept a log of the heart’s electrical activity throughout the recording period.
It was cumbersome, said Dr. Tee, and usually had to be worn for a period of 30 days. Because episodes of arrhythmia can come and go, the patient might not experience an episode within the 30-day period. “If the patient passes out on day 32,” said Dr. Tee, the process would have to be started again, and insurance typically doesn’t cover a second monitoring period.
About five years ago, he continued, a procedure was developed by Medtronic, in which a device about 2.25“ long and ¾“ wide – the Reveal XT – is surgically implanted beneath the skin of the chest. It is able to monitor the heart continuously and record the data to a receiver placed next to the patient’s bed. The data is immediately sent to Medtronic, via landline telephone connection, and, if an irregularity is detected, the physician is quickly alerted.
This monitor, Dr. Tee explained, is similar to a pacemaker in size and positioning, but unlike a pacemaker, it is diagnostic only. A vast improvement over the Holter is the inserted monitor’s diagnosis rate: 96 to 97 percent, compared to the Holter’s 20 percent.
Without the cumbersome wiring a patient must contend with while wearing the Holter monitor, the implanted XT monitor can remain in place longer and more comfortably, as the battery lasts up to five years. It is, however, clearly visible beneath the skin. It can also be challenging to position properly in thin patients, who don’t have as much area with sufficient tissue to place the device in proper proximity to the heart.
The most recent technology, not yet widely available, is the Reveal LINQ, a tiny device, no larger than a paperclip and exceedingly thin. It is like the older model in that it monitors the heart 24/7, and its batteries last three years. In addition, the LINQ monitor does not require a landline connection but uses a satellite to transmit information, thus allowing the patient far more mobility. The smaller device is also more sensitive and therefore not as position-dependent as the larger one. From a cosmetic aspect, the tiny monitor is not visible in most patients.
Walters explained that surgical instruments are not needed to place the LINQ, as they are with the larger device, thus greatly reducing the chance of infection. Only a very tiny incision is required, after which the device is injected just below the skin. In most cases, he added, “you don’t need to suture, just a bandaid and you’re done. Although the procedure does take place in a surgical center it is almost like an office visit, with just a local (anesthesia), and it takes an hour at most, usually less.”
Procedures using the tiny new monitor are very new and as of April 16, only five have been performed between the SRMC facility and the Heart Center, Walters said. He emphasized that Dr. Tee is able to provide “continuity of care” by performing not only the monitoring procedure, but also any necessary indicated follow-up treatment, which can add significant comfort and convenience to a patient’s experience.
“People had fainting spells for years and there was no answer,” Walters said, ”but now there is.” He feels strongly that there is valuable medical information to be had from such sources as the internet and that, the more informed people become, the better equipped they will be to seek the medical support they need and live the healthy life they desire.