[Indications for loop recorder implantation for syncope]

Implantable loop recorder with discontinuous ECG recording enables monitoring of heart rhythm over several years. Consequently, in patients with recurrent syncope it is possible to record an ECG during the next syncopal event to obtain symptom-ECG correlations. In patients with recurrent syncope of unknown origin, the implantation of a loop recorder leads to an earlier diagnosis and an asystole is more often detected as the cause of the recurrent syncope. In addition, the loop recorder identifies patients who will benefit from pacemaker implantation. An established indication for early implantation of a loop recorder is given in patients with recurrent syncope and no high-risk marker, e. g., reduced left ventricular function, valve disease, history of myocardial infarction or ECG findings such as bifascicular block, pre-excitation, long QT syndrome or an epsilon wave. These patients should receive a complete cardiological work-up with the aim of detecting the underlying heart disease. Patients with no conclusive findings should also receive a loop recorder. A relative indication is given for patients with recurrent syncope and injuries in order to predict the effect of pacemaker implantation. Possible indication is given for patients with transient loss of consciousness to rule out an arrhythmogenic origin.