First treatment identified for fainting- ESC Update
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Fainting affects one in two people during their lifetime. Those with recurrent episodes are often afraid to socialise or go to work. Researchers report the first effective therapy presented at ESC Congress 2020.

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.

Source: https://www.escardio.org/The-ESC/Press-Office/Press-releases/first-treatment-identified-for-fainting
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