My heart stops when I faint/ blackout. Do I need a pacemaker?

Dr Boon Lim, Consultant Cardiologist and Clinical Lead for the Imperial Syncope Diagnostic Unit Hammersmith Hospital has recently published an article analysing the long term outcomes in patients who have syncope (fainting) who appear to have long pauses on tilt table testing (> 15 seconds heart stopping (asystole). The majority of patients appear to do extremely well, even in the absence of pacemaker therapy, which underscores the importance of adhering to the conservative advice such as:-

1) increasing fluid intake and keeping well hydrated

2) recognising situations which provoke fainting, and avoiding these.

3) performing isometric counter-pressure measures such as teeth and buttock clenching and tensing of the leg muscles to avoid an impending faint

Of the 26 patients reported to have prolonged episodes of asystole on tilt testing (>15s), only 6 patients had pacemaker implantation, but even 80% of patients without pacemaker therapy had improved with conservative advice outlined above after a follow-up period of 8 years.

In summary, a majority of patients with asystole on tilt testing can improve if adhering to simple conservative advice as outlined.

To see a syncope specialist in London, please contact LCC on : 02074360669


A long-term follow-up of patients with prolonged asystole of greater than 15s on head-up tilt testing.

Sau A, Mereu R, Taraborrelli P, Dhutia NM, Willson K, Hayat SA, Francis DP, Sutton R, Lim PB.

Int J Cardiol. 2015 Oct 21;203:482-485.

Posted on 17 November 2015
Author: LCC
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