Key result
Prolonged monitoring for unexplained syncope increases diagnostic yield by ~135% and lowers costs vs conventional testing.
Why the study?
Establishing a diagnosis in unexplained syncope is difficult due to infrequent events, and the cost-effectiveness of immediate prolonged monitoring versus conventional diagnostic strategies had not been studied.
Does prolonged monitoring with an implantable loop recorder improve diagnostic yield and reduce costs compared to conventional testing in patients with unexplained syncope?
RCT (n=60)
Does prolonged monitoring with an implantable loop recorder improve diagnostic yield and reduce costs compared to conventional testing in patients with unexplained syncope?
Absolute Event Rate: 47% vs 20%
p-value: p=0.029
A strategy of primary prolonged monitoring with an implantable loop recorder is more cost-effective and provides a higher diagnostic yield than conventional testing in patients with recurrent unexplained syncope.
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Supports targeted syncope pathways to curb costs; leaves open randomized confirmation of efficiency gains.
Krahn et al. (2003) conducted an RCT in unexplained syncope (n=60). Prolonged monitoring with an implantable loop recorder vs. Conventional testing with an external loop recorder, tilt and electrophysiologic testing was evaluated on Diagnostic yield (p=0.029). Prolonged monitoring increased diagnostic yield (47% vs 20%, p=0.029) and lowered cost per diagnosis ($5,852 vs $8,414, p<0.0001) compared to conventional testing for unexplained syncope.
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