Implantable diagnostic monitors in the early assessment of syncope and collapse

The implantable diagnostic monitor, or loop recorder (ILR) is a subcutaneous monitor capable of continuous ECG monitoring up to 3 years. It is an elegant investigative tool for the assessment of patients with recurrent, unexplained syncope in whom an arrhythmic cause needs to be excluded, and is now increasingly utilised very early in the diagnostic work-up of these patients, in line with current guidelines. This review examines the evidence underpinning these recommendations as well as the relevant clinical trials evaluating the use of the ILR in syncope. Continued research will be needed to validate its role as a first line investigation in a sub-select of syncopal patients, especially with the addition of remote monitoring capabilities.