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The following is a summary of “Usefulness of last generation insertable 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 insertable cardiac monitor (ICM) early in evaluation. 

Researchers conducted a prospective study examining the effectiveness of the latest ICM model in identifying US causes, tracking arrhythmias, syncope recurrence, and leading to cardiac electronic device (CIED) implants, while analyzing patient characteristics linked to higher arrhythmia and recurrence risk.  

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

The results showed that among 109 patients (mean age 64.4 ± 16.1 years; 40.4% women) with unexplained syncope or presyncope, the LG-ICM achieved a 42% diagnostic yield over an average 11.7 ± 8.1-month follow-up. LG-ICM identified arrhythmias in 29 patients (27%), including 6 during syncope recurrence, and ruled out 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). 

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 workload. Age ≥ 65 and a history of atrial arrhythmias predict significant findings. 

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