Utility and cost of event recorders in the diagnosis of palpitations, presyncope, and syncope

There are many etiologies for palpitations, presyncope, and syncope. Establishing a definitive diagnosis is important because these symptoms may be benign, or may herald an ominous prognosis. The usual evaluation, including a history, physical examination, and electrocardiogram suggests a cause for symptoms in approximately 50% of patients.(1) When the etiology remains unexplained, other techniques including head-up tilt table testing, electrophysiologic testing (EPS) and long-term ambulatory recording may be useful.(2-4) Event recorders are small electrocardiographic recording devices used for various time periods. The patient can save the recording by manually triggering the device, which stores the rhythm for later playback. Some devices allow capture of both retrospective and prospective recordings. This investigation prospectively evaluates the cost and diagnostic utility of event recorders.