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Older couple drinking coffee

Jean Kehler and Larry Thorn can relax, since an implantable loop recorder helped diagnose her fainting spells.  

More Than a Lucky Catch

Wilma Jean Bender Kehler was walking through her kitchen when she suddenly felt faint. “I heard her say ‘Oh!’ and caught her as she started to go down,” says Larry Thorn, Jean’s friend and companion.

“I could tell something was happening,” Jean says. “I never felt dizzy, but I knew I needed to grab onto something or sit down, quick.”

At age 87, Jean is no stranger to inconveniences from her health. She and Larry help each other navigate their medical regimens and appointments, trying to minimize interferences.

After that first fainting spell in the kitchen, Jean had two or three more episodes in the following weeks. She was determined not to let them keep her from her routine, as they passed quickly. “But still, we thought there might be something wrong.”

After Jean experienced an episode while waiting in line at a store, she decided something had to be done. “We went to our home doctor, Dr. John Deck, and he said Jean was definitely having a problem but maybe not related to her previous stroke, so he referred her to Bryan Heart,” Larry remembers.

What is syncope?

Jean was experiencing syncope, or fainting spells caused by a period of inadequate blood flow to the brain. Syncope is common among people over 75, but it can occur at any age, with or without other medical issues. There is no single best treatment, and testing and monitoring over several weeks or months may be needed before doctors can diagnose the source of the problem and recommend a treatment.

“Traditionally patients with these symptoms wear a Holter heart monitor for 24 hours to establish a diagnosis,” says cardiac electrophysiologist W. Michael Kutayli, MD, of Bryan Heart. “Some patients wear the monitor for two weeks to a month, because these arrhythmias can be sporadic and difficult to detect.”

But Dr. Kutayli was able to diagnose Jean and get her treated with a technology he prescribed for her nearly three years before — a subcutaneous heart rhythm monitor, often called an implantable loop recorder.

Long-term data makes difference

The loop recorder is a cardiac monitor implanted just under the skin, near the heart. The device is about the size of a AAA battery and connects to a mobile application, providing data about the heart’s rhythms. It’s a simple, outpatient procedure that takes minutes and requires no anesthesia. After implantation, doctors can check the patient’s data remotely, and patients can follow their information at home.

“All you need is a cellular signal and a power outlet,” Dr. Kutayli says. “There also are smart phone applications that allow patients to mark when they are having symptoms with a few simple clicks. And they don’t need to come in for follow ups while we’re monitoring with a subcutaneous cardiac device.”

The best part: Patients can keep the monitor for up to three years. That extended time period allows physicians to see long-term trends and gives the best possible opportunity for detecting arrhythmias. Dr. Kutayli was just about to remove Jean’s loop recorder when it provided the information needed for treating her syncope.

Using technology for diagnosing

Jean came to Bryan Heart in 2015 after she experienced an acute, cryptogenic stroke — or a stroke of unknown origin. Dr. Kutayli suspected that atrial fibrillation — an irregular heartbeat — might have been the cause.

Dr. Kutayli wanted to give Jean the most effective, minimally invasive course of treatment, so he recommended the implantable loop recorder to confirm atrial fibrillation as the cause of her stroke. Physicians use the monitor for patients who fall into four broad categories of symptoms: unexplained stroke, heart palpitations, fainting and to detect atrial fibrillation.

Diagnosed, treated and home in days

When Jean came in for treatment for her syncope, her heart rate was in the 30s while she was awake — much lower than it should have been. Dr. Kutayli recommended and implanted a pacemaker. 

“I’ve been feeling really good since then,” Jean says.

Dr. Kutayli says that Jean’s speedy diagnosis and recovery is a direct result of the technology available at Bryan Health.

“Research shows that many patients don’t have signs of arrhythmia until 120 days after receiving the implanted loop recorder," Dr. Kutayli says. “We never would have been able to make both Jean’s stroke and syncope diagnoses as quickly and easily with a traditional heart monitor. We’re so dependent on technology in my field, and Bryan Health provides us with the latest technology so that patients don’t have to travel elsewhere to receive the best care.”


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