Ambulatory ECG monitoring for syncope and collapse in United States, Europe, and Japan: The patients’ viewpoint

Meltem Altinsoy, Richard Sutton, Ritsuko Kohno, Scott Sakaguchi, Robin K. Mears, David G. Benditt

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Practice guidelines provide clinicians direction for the selection of ambulatory ECG (AECG) monitors in the evaluation of syncope/collapse. However, whether patients’ understand differences among AECG systems is unknown. Methods and Results: A survey was conducted of USA (n = 99), United Kingdom (UK)/Germany (D) (n = 75) and Japan (n = 40) syncope/collapse patients who underwent diagnostic AECG monitoring. Responses were quantitated using a Likert-like 7-point scale (mean ± SD) or percent of patients indicating a Top 2 box (T2B) for a particular AECG attribute. Patient ages and diagnosed etiologies of syncope/collapse were similar across geographies. Patients were queried on AECG attributes including the ability to detect arrhythmic/cardiac causes of collapse, instructions received, ease of use, and cost. Patient perception of the diagnostic capabilities and ease of use did not differ significantly among the AECG technologies; however, USA patients had a more favorable overall view of ICM/ILRs (T2B: 42.4%) than did UK/D (T2B: 28%) or Japan (T2B: 17.5%) patients. Similarly, US patient rankings for education received regarding device choice and operation tended to be higher than UK/D or Japan patients; nevertheless, at their best, the Likert scores were low (approximately 4.7-6.0) suggesting need for education improvement. Finally, both US and UK/D patients were similarly concerned with ICM costs (T2B, 31% vs 20% for Japan). Conclusions: Patients across several geographies have a similar but imperfect understanding of AECG technologies. Given more detailed education the patient is likely to be a more effective partner with the clinician in establishing a potential symptom-arrhythmia correlation.

Original languageEnglish (US)
Pages (from-to)1023-1030
Number of pages8
JournalJournal of Arrhythmia
Issue number4
StatePublished - Aug 2021

Bibliographical note

Funding Information:
Dr Benditt is a consultant to and holds equity in Medtronic Inc, and Abbott Laboratories, and is supported in part by a grant from the Dr Earl E Bakken family in support of Heart‐Brain research. Dr Sutton is a consultant to Medtronic Inc, serves on a Speaker's bureau for Abbott Laboratories (St Jude Medical, Inc), holds equity in Edwards LifeSciences Corp and Boston Scientific Inc. Dr Sakaguchi has been a consultant to BioTel Inc, an ambulatory ECG monitoring company. Robin Mears is an employee of Medtronic Inc, and holds equity in Medtronic Inc. Other authors have no conflicts to declare.

Funding Information:
The authors wish to acknowledge the patients who participated in this survey. The survey reported here was funded by Medtronic Inc, Minneapolis, Minnesota. Dr Benditt is supported in part by a grant from the Dr Earl E Bakken Family in support of heart‐brain research. Ms Mears is a Medtronic employee.

Publisher Copyright:
© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society


  • ambulatory ECG monitoring
  • insertable cardiac monitors
  • syncope


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