How a brand new hi-tech pacemaker with a battery lasting 25 years has saved Emily Coles’ life – after she fainted out of the blue

After Emily Coles suddenly collapsed at home, she had to put her life on hold while doctors investigated the cause.

Emily now knows that her heart had stopped beating for ten seconds, but at the time she had no idea her life was at risk.

Emily, 24, had been having coffee with her elder sister Lauren in September last year in her kitchen when she dropped to the ground.

‘One minute we were having a catch-up, the next I was on the floor,’ says Emily, a nurse, who lives with her mother Karen, 56, and father Nigel, 58, in Rotherham, South Yorkshire. 

‘The only thing I can remember was feeling a bit light-headed.’Lauren, 28, who is training to be a doctor, was so concerned that she took Emily to A&E, where she was seen by a specialist cardiac physiologist.

Emily underwent tests, including an electrocardiogram and a tilt test, where the patient lies flat on their back on a motorised table, which tilts to a nearly vertical position for 45 minutes. 

Heart rate and blood pressure are monitored throughout, to see how different positions affect the patient’s heart.

After half an hour upright on the tilt table, Emily suddenly passed out. As she did so, the monitors showed that her heart had stopped beating. 

She was diagnosed with reflex syncope, where the heart slows so much it leads to a temporary loss of consciousness (syncope is the medical term for fainting).

Worryingly, Emily’s heart was stopping for ten seconds or more at a time.

She was told she needed a pacemaker – becoming one of the more than 500,000 people in the UK every year who have one implanted. 

But Emily was one of the first to have a new hi-tech pacemaker, which comes with a battery that should last 25 years – more than twice as long as previous models – and has a lower risk of complications.

While doctors don’t know what caused Emily’s condition, looking back now she recalls that in the two years before this she’d sometimes felt dizzy – ‘I’d have to hold on to something to steady myself,’ she says. But tests at the time, including an echocardiogram (an ultrasound to inspect the heart), had found nothing.

After her collapse and diagnosis last year, Emily was barred from driving.

This made it harder for her to get to work – and her 12-hour shifts at a busy hospital – as well as taking away her social life and making her nervous to go out.

She was also told to drink more water and eat more salt, both of which help keep up blood pressure and avoid the dips which can lead to fainting.

But to keep her condition under control long-term, heart specialists at Sheffield Teaching Hospitals NHS Foundation Trust, where Emily (pictured) was being treated, said she needed to be fitted with a pacemaker to prevent future life-threatening collapses.

Usually a pacemaker is implanted via a small 5cm incision in the left side of the chest. The wires that connect the pacemaker to the heart are fed through a vein to the heart, before the pacemaker is slotted in just below the collarbone.

The device senses through the wires what the heart is doing, and if it slows or misses a beat, the pacemaker fires off an electrical impulse to restore it to its normal rate.

The downsides of conventional pacemakers include the leads potentially malfunctioning. They also last only about ten years before having to be replaced.

For Emily, this could mean multiple replacements over her lifetime, making her vulnerable to the risks of surgery, such as infection and sepsis.

 A 2019 study by Manchester University NHS Foundation Trust, published in the journal PLOS One, found that over a two-year period the Trust dealt with 84 cases of pacemaker-related infections, with half those patients needing emergency surgery.

Not only were patients’ lives at risk, but it cost the trust nearly £25,000 per patient to tackle the problem.

Dr Nigel Lewis, a consultant cardiologist who treated Emily, says: ‘We try to avoid putting pacemakers in young people, as they have to be replaced.’ 

However, Emily’s pacemaker, which is roughly the size of an AAA battery, requires less invasive surgery and has fewer associated risks.

The implant has a battery and electronic chips all housed within its compartment. Crucially, it has a much longer battery life than conventional pacemakers – up to 25 years.

It also doesn’t have leads, avoiding the kind of malfunction that would require the pacemaker to be changed.

In January, Emily became one of the first patients in the UK to have the leadless pacemaker fitted during a one-hour procedure under local anaesthetic.

A thin tube (a catheter) was inserted into a vein in her leg and fed up to the right ventricle – one of the two lower chambers of the heart. 

Doctors then fed the tiny pacemaker through the tube and fixed it with tiny hooks to the septum, the wall of tissue that divides the right and left ventricles.

In a two-year trial, the leadless pacemaker, which was developed in the US, was shown to be as effective as traditional devices.

Dr Lewis says: ‘It can be game-changing for younger patients and for those on kidney dialysis who have long-term lines in their bodies. 

‘If it gets infected, a traditional pacemaker can easily infect these lines too.

‘In some breast and lung cancer patients who have radiotherapy, the treatment can cause blockages in the veins, which makes it difficult to fit a traditional pacemaker.

‘So this new pacemaker could benefit hundreds of patients to start with, then long-term it will be in the thousands.’

For Emily, it has been life-changing. ‘I found it difficult to come to terms with the fact I needed a pacemaker at 24,’ she says. 

‘Sometimes I can feel it pacing the rhythm of my heart, which feels like a weird flutter at the base of my neck.

‘But I feel like I’ve got my life back on track. I’m driving again and have reinstated my gym membership. I took it all for granted before my diagnosis but am so excited to be active again.’