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Syncope is a frequent reason for medical consultation and hospital admission and is associated with high health service use and costs.1 ,2 From the pathophysiological standpoint, syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion and can be the final common pathway of different conditions, whose prognosis is highly heterogeneous.3 Indeed, cardiovascular syncope (due to bradyarrhythmias or tachyarrhythmias or structural heart disease) is associated with significant morbidity and mortality, while the prognosis of reflex syncope (vasovagal, situational and carotid sinus syndrome) and syncope due to orthostatic hypotension is generally benign.4
Implantable loop recorders (ILRs) are small devices implanted or injected subcutaneously in the left side of the chest under local anaesthesia. They continuously record and delete a bipolar ECG signal with no need for intravascular leads and have a battery capable of storing significant events for up to 36 months. Thanks to their ability to register the patients' ECG during spontaneous symptoms, ILRs have gained popularity and are now recommended as an early diagnostic tool in the evaluation of unexplained syncope.3 However, randomised clinical trials (RCTs) proving that an ILR-guided diagnosis and treatment changes clinically relevant outcomes, besides increasing the diagnostic rate, are essential to support their use in clinical practice.
We conducted a Cochrane review of RCTs to compare ILRs and …