Arrhythmic syncope: From diagnosis to management

Table 2 Main advantages, limitations, and indications of the most commonly used devices for electrocardiogram cardiac monitoring in patients with syncope

	Advantages	Disadvantages	Main indications
24-hr holter	Continuous recording: 12 leads with good correlation with surface ECG; low economic cost per study	Discomfort for the patient; artifacts; maximum recording of 24-48 h (low diagnostic yield); high economic cost per diagnosis	Very frequent (daily) symptoms; in-hospital monitoring (if ECG-telemetry not available)
Skin patches	Continuous recording of 7-14 d; good tolerability for patients	Single-use and greater economic cost; only one lead1; low diagnostic yield	Frequent (weekly) symptoms
External loop recorders	Loop recording (includes beginning and end of arrhythmic event); monitoring for 4 wk; low economic cost per study	Patient discomfort; requires education from healthcare professional on how to correctly place the electrodes; relatively low diagnostic yield	Frequent (weekly-monthly) symptoms
Implantable loop recorders	Loop recording; up to 3-yr monitoring (good diagnostic yield); patient does not have to do anything; remote monitoring	Invasiveness and associated complications (infection, bleeding, etc.); individual economic cost; single lead	Infrequent symptoms; most useful in syncope

¹There are devices with more leads.

ECG: Electrocardiogram.