Version June 2024
| Recommendations | Class* | LevelΔ |
| Indications | ||
| ECG monitoring is indicated in patients who have clinical or ECG features suggesting arrhythmic syncope (listed in the "Risk stratification for syncope" table). The duration (and technology) of monitoring should be selected according to the risk and the predicted recurrence rate of syncope: | I | B |
| • Immediate in-hospital monitoring (in bed or telemetric) is indicated in high risk patients (as defined in the "Risk stratification for syncope" table) | I | C |
| • Holter monitoring is indicated in patients who have very frequent syncope or pre-syncope (≥one per week) | I | B |
| • ILR is indicated in: | ||
| - An early phase of evaluation in patients with recurrent syncope of uncertain origin, absence of high risk criteria, and a high likelihood of recurrence within battery longevity of the device | I | B |
| - High risk patients (as defined in the "Risk stratification for syncope" table) in whom a comprehensive evaluation did not demonstrate a cause of syncope or lead to a specific treatment | I | B |
| • ILR should be considered to assess the contribution of bradycardia before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes | IIa | B |
| • External loop recorders should be considered in patients who have an inter-symptom interval ≤four weeks | IIa | B |
| Diagnostic criteria | ||
| ECG monitoring is diagnostic when a correlation between syncope and an arrhythmia (brady- or tachyarrhythmia) is detected | I | B |
| In the absence of such correlation, ECG monitoring is diagnostic when periods of Mobitz II or III degree AV block or a ventricular pause >3 s (with the possible exception of young trained persons, during sleep, medicated patients, or rate-controlled atrial fibrillation), or rapid prolonged paroxysmal SVT or VT are detected. The absence of arrhythmia during syncope excludes arrhythmic syncope. | I | C |
| The ECG documentation of pre-syncope without any relevant arrhythmia is not an accurate surrogate for syncope | III | C |
| Asymptomatic arrhythmias (other than those listed above) are not an accurate surrogate for syncope | III | C |
| Sinus bradycardia (in the absence of syncope) is not an accurate surrogate for syncope | III | C |
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