When V.S. Prasad (58), a former steel plant executive based in Durgapur, West Bengal, fainted in the bathroom in September, doctors could not immediately fathom the cause. Was the syncope (a temporary loss of consciousness) a heart-related problem or a neurological one?
All standard tests such as the echocardiogram (ECG), proved inconclusive. Says Arunangshu Ganguly, consultant interventional cardiologist at Apollo Gleneagles Hospital, Kolkata: “The 24-hour Holter monitoring (an ambulatory electrocardiography device) did not show anything. The tilt test (a medical procedure used to detect syncope) was negative and the neurologist ruled out epilepsy.”
Cardiologists say they are often at a loss in cases such as these. R.R. Mantri, consultant interventional cardiologist at Sir Ganga Ram Hospital in New Delhi, says that 40% of such cases defy diagnosis. He says many patients complaining of fainting spells are treated as epileptics and the cardiac problem goes undetected.
The vice-versa is also true, with several epileptics wrongly implanted with pacemakers, points out Praveen Chandra, interventional cardiologist at Max Healthcare, New Delhi.
Dr Ganguly suspected there was an electrical problem in Prasad’s heart. He likens the heart to an electromechanical pump with the power supply originating from the sinus node—the heart’s natural pacemaker. Yet, there was no evidence to back his intuition.
The Reveal Insertable Loop Recorder, a probing device that was launched in October in India, came to his aid. The implantable device records the way the heart behaves and provides evidence of what goes wrong during fainting spells. Although new in India, it has been in the US market for some years now.
On 12 December, Prasad suffered another fainting spell during his morning puja. As soon as he regained consciousness, he pressed the activator button that would make Reveal start storing the data about how his heart had behaved during the episode. When Dr Ganguly and his team arrived and analysed the data, they realized that Prasad’s heart had stopped beating for nearly 20 seconds.
From this, it was clear that the problem originated in the heart. What’s more, the device also pinpointed that Prasad suffered from a case of abnormally slow heart rate (anything less than 60 beats a minute is cause for worry).
That was significant information because, as Dr Mantri points out, the therapy is different for patients with abnormally slow heart rate and those with an unusually fast heart rate (more than 100 beats a minute).
With the results from this device, the line of treatment is clear now—Prasad will need a pacemaker. As Dr Ganguly puts it: “This has helped us in providing evidence-based treatment rather than going in for presumptive management.”
What it costs: Rs35,000. However, if the fainting spell is found to be due to a heart problem and the patient requires a pacemaker, the company will deduct the cost of this device from the pacemaker’s cost.
The procedure: The thumb-sized device is inserted under the skin through a non-invasive out-patient procedure under local anaesthesia.
How it works: Much like a black box in an aeroplane, Reveal records vital information during an actual incident, which can be played back for detailed analysis. It has a battery life of 14 months and can continuously record the heart’s rhythm for this period.
Who will it benefit: About 1.5 million people worldwide suffer from unexplained syncope. In almost 10% of patients, syncope has a cardiac cause; in 50%, a non-cardiac cause; and in 40%, the cause is unknown.
What’s next: Reveal DX—with a battery life of 36 months, to be followed by Reveal XT. It also has a battery life of 36 months but comes equipped with an AF algorithm to detect atrial fibrillation (abnormal heart rhythm).