Ambulatory ECG Monitoring for Unexplained Syncope

Half of patients with syncope who present to an emergency department (ED) leave without a definitive diagnosis despite a full workup. Given the possibility of an underlying cardiac cause in these patients, is postdischarge ambulatory electrocardiographic (ECG) monitoring worthwhile?

To address this question, researchers conducted a pragmatic, open-label study at 45 U.K. hospitals. They randomized 2200 adults (mean age, 58) with unexplained syncope (i.e., excluding vasovagal episodes and orthostatic syncope diagnosed after full ED workup) to receive a 14-day ambulatory ECG monitoring device or standard care (Figure 1). A portion of patients in both groups received non-intervention monitoring (telemetry in admitted patients; or 1 to 7 d…