Long-term ambulatory ECG monitoring in syncope: The state of the art

Syncope is a common clinical condition that frequently remains undiagnosed despite extensive diagnostic testing. Fear of undetected cardiac arrhythmias as a cause of syncope often drives physicians and patients toward elaborate and invasive diagnostic workups. In this paper, we review the use of long- term ambulatory loop electrocardiographic recorders in syncope. These devices can be worn for months at a time, and may capture the cardiac rhythm at the onset of symptoms. Careful selection of patients for monitoring is essential, as many devices require that patients be attentive to detail and compliant with numerous areas of monitor use. Patient education is also required to help patients learn the routine of long-term monitoring. Through careful selection and education of patients, and with the development of newer generations of 'user friendly' long-term monitors, heart rhythm during symptomatic episodes may be captured in up to 50% of patients with recurrent syncope.