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The following is a summary of “Utility of latest generation implantable cardiac monitors in the diagnosis of unexplained syncope”, published in the October 2024 issue of Cardiology by Arabia et al.

For cases of unexplained syncope (US) with suspected arrhythmias, guidelines suggest using an implantable cardiac monitor (ICM) early in the evaluation.

Researchers conducted a prospective study examining the effectiveness of the latest ICM model to identify US causes, track arrhythmias, syncope recurrence, and lead to cardiac electronic implant (CIED), while analyzing patient characteristics linked to higher arrhythmias and recurrence risk.

They included patients who received the latest generation ICM for unexplained syncope or presyncope between November 2020 and January 2023 and their data were collected and analyzed prospectively.

Results showed that among 109 patients (mean age 64.4 ± 16.1 years; 40.4% female) with unexplained syncope or presyncope, LG-ICM achieved a diagnostic yield of 42% over a mean of 11.7 ± 8.1 months follow-up. LG-ICM identified arrhythmias in 29 patients (27%), including 6 during syncope recurrence, and excluded arrhythmic syncope in 19 (17%) patients. It led to CIED implantation in 16 patients (15%) due to asystole or severe bradycardia. Age ≥ 65 years (P=0.012) and atrial arrhythmia history (P=0.004) independently predicted arrhythmic diagnosis, while CAD slightly predicted syncope recurrence (P=0.056).

The investigators concluded that the diagnostic yield of LG-ICM for unexplained syncope is similar to that of ILR and earlier ICM models, with the added benefit of reduced hospital burden. Age ≥ 65 and a history of atrial arrhythmias predict significant findings.

Source: sciencedirect.com/science/article/pii/S0167527324009239