Background and rationale
arrhythmia, heart disease, syncope, Syncope, cardiac arrhythmia, neurocardiogenic, cardiac disease
RECURRENCE, ARRHYTHMIA, HEART DISEASE, SIMPLE FAINT, CARDIAC ARRHYTHMIA, CARDIAC DISEASE, POSTURAL HYPOTENSION
Syncope (or blackout) is common; 650 000 patients present to UK emergency departments (EDs) every year. The three underlying causes are neurocardiogenic (including simple faint), postural hypotension (blood pressure fall on standing) and cardiac disease (structural heart disease or cardiac arrhythmia). Diagnosis is difficult and is not made in around 50% of patients after assessment.The difficulty in the ED is to differentiate between the causes of syncope and identify patients at higher risk. This can be complicated as many patients have fully recovered on ED arrival and their examination and presenting ECG may both be normal. The current method for establishing cardiac arrhythmia as the cause of syncope rests on correlating the arrhythmia with symptoms. The lack of efficacy and availability of commonly used monitoring devices means most high and medium risk patients are admitted to the hospital for observation and telemetry (if available), with escalating costs.In general, syncope reoccurs in around 50% of patients within a year. Recurring episodes increase hospital admissions, health costs and importantly reduce the quality of life of patients. While there is a wide variation in the literature with respect to the number of syncope episodes and recurrence rates pretreatment and post-treatmentThere is evidence that the diagnostic yield for detecting underlying arrhythmia is highest when cardiac monitoring devices are applied early after syncope, ideally at the index visitThe ASPIRED RCT will compare a novel ambulatory cardiac monitoring device with standard practice in syncope patients. We hypothesise that applying cardiac monitoring early after syncope at the index visit is the optimum strategy to detect, diagnose, treat and exclude underlying cardiac arrhythmia.