Wearable ECG monitor improves arrhythmia detection after syncope

A 14-day wearable ECG monitor started immediately after emergency department evaluation for unexplained syncope did not reduce patient-reported recurrent episodes at one year compared to standard care, according to the ASPIRED trial presented at the European Society of Cardiology Congress. However, early monitoring more than doubled the detection of serious arrhythmias, identifying them in 22% of patients versus 9% with standard care, and led to more patients receiving treatments such as pacemakers or antiarrhythmic therapy. The trial, published in The New England Journal of Medicine, included 2,234 patients across 45 UK emergency departments. All-cause mortality at one year was lower in the early monitoring group at 1.5% versus 2.9% in standard care, though researchers noted the open-label design and lower-than-anticipated syncope recurrence as limitations. The ongoing REMOSYNCED trial will further evaluate this monitoring approach in different clinical settings.