Immediate Ambulatory Electrocardiographic Monitoring in Syncope.
Matthew J Reed, Steve Goodacre, Christopher J Weir et al.
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In 30 seconds
This open-label, multicenter randomized controlled trial compared 14-day ambulatory ECG monitoring with site-specific standard care in adults whose syncope remained unexplained after emergency department evaluation. Among 1,970 patients included in the primary analysis, the mean number of patient-reported syncope episodes at 1 year was 1.37±5.10 with monitoring and 1.58±8.56 with standard care (incidence rate ratio, 0.89; 95% confidence interval, 0.68 to 1.18; P = 0.42). Thus, monitoring did not significantly reduce reported episodes at 1 year. Adverse events were reported more often in the monitoring group.
Key findings
- At 1 year, mean syncope episodes were 1.37±5.10 with monitoring and 1.58±8.56 with standard care (incidence rate ratio, 0.89; 95% confidence interval, 0.68 to 1.18; P = 0.42).
- There were 49 adverse events in the intervention group and 8 in the standard-care group; each group had 1 serious adverse event.
Why it matters
Unexplained syncope can be difficult to evaluate for an underlying arrhythmia. In this trial, offering 14-day ambulatory ECG monitoring did not significantly reduce patient-reported syncope episodes over 1 year compared with standard care. The findings help distinguish the use of monitoring as a diagnostic strategy from evidence of improved symptom outcomes.
What to keep in mind
The primary outcome was patient-reported syncope episodes, and patients who completed no follow-up were excluded from the primary analysis.