ASPIREDHot Line 10Devices & ArrhythmiasNew England Journal of Medicine
Ambulatory Electrocardiographic Monitoring for Unexplained Syncope After Emergency Evaluation
Immediate Ambulatory Electrocardiographic Monitoring in Syncope
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Presenting authorMatthew James ReedCross-Cutting Cardiology · NHS LothianMatthew J. Reed is Professor of Emergency Medicine at the University of Edinburgh and a Consultant in Emergency Medicine at the Royal Infirmary of Edinburgh, NHS Lothian. He is Research Director of the Emergency Medicine Research Group Edinburgh (EMERGE) and Chair of the Royal College of Emergency Medicine Research Committee. He is a member of the European Society of Cardiology Syncope Task Force.
Key result
14-day ambulatory ECG monitoring did not significantly reduce the mean number of patient-reported syncope episodes at 1 year compared to standard care (IRR 0.89; 95% CI 0.68-1.18; P=0.42).
Discussion
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Overview
Immediate 14-day ECG monitoring does not reduce syncope recurrence at 1 year; challenges routine adoption despite higher arrhythmia detection in unexplained syncope.
Key Points
- To assess whether immediate 14-day ambulatory electrocardiographic (ECG) monitoring reduces recurrent syncope episodes at 1 year in patients presenting to the emergency department with unexplained syncope.
- Open-label, randomized controlled trial conducted across 45 hospitals in the United Kingdom (ISRCTN10278811).
- Enrolled 2234 adults with syncope unexplained after emergency department evaluation, randomly assigned 1:1 to receive 14-day ambulatory ECG monitoring (N=1123) or standard care (N=1111), with 1-year follow-up.
- In the primary analysis (N=1970), the mean (±SD) number of patient-reported syncope episodes at 1 year was 1.37±5.10 in the intervention group versus 1.58±8.56 in the standard-care group (incidence rate ratio, 0.89; 95% CI, 0.68 to 1.18; P=0.42).
- Adverse events occurred in 49 patients in the 14-day monitoring group versus 8 patients in the standard-care group, with 1 serious adverse event reported in each arm.
Study Design
Type
RCT (n=2,234)
Blinding
Open-label
Randomization
1:1 ratio
Multicenter
Yes
Structured PICO
Does 14-day ambulatory ECG monitoring reduce the mean number of patient-reported episodes of syncope at 1 year in adults with unexplained syncope after emergency department evaluation?
P
Population
2,234 adults with unexplained syncope after emergency department evaluation, randomized to 14-day ambulatory ECG monitoring or standard care, followed for 1 year.
I
Intervention
14-day ambulatory electrocardiographic (ECG) monitoring
C
Comparator
Standard care provided for patients with unexplained syncope at each participating site
O
Outcome
Mean number of patient-reported episodes of syncope at 1 yearpatient reported
In patients with unexplained syncope after emergency department evaluation, 14-day ambulatory ECG monitoring did not significantly reduce patient-reported syncope episodes at 1 year compared to standard care.
Main Result
Relative Risk: 0.89 (95% CI 0.68–1.18)
Absolute Event Rate: 1.37% vs 1.58%
p-value: p=0.42