Wearable monitor improves diagnosis of heart rhythm disorders after fainting
Early ECG monitoring initiated in the emergency department (ED) has the potential to transform the care of thousands of patients who visit the ED with unexplained fainting.
A new study, presented at ESC Congress 2026 and published in the New England Journal of Medicine, suggests that wearing a 14-day ECG monitor immediately after fainting in the emergency department could significantly improve diagnosis and treatment of heart rhythm disorders. The ASPIRED trial involved 2,233 adults with unexplained fainting who were randomized to either wear an ECG monitor or receive standard care.
The monitor recorded the patient's cardiac rhythm continuously and allowed them to press a button if another syncopal episode occurred. The primary endpoint showed no significant difference in the number of self-reported fainting episodes between the two groups at one year. However, the monitoring group had a 22% detection rate of clinically significant cardiac arrhythmias compared to 9% in the standard care group, indicating that monitoring more than doubled the detection of serious heart rhythm issues.
The median time to diagnosis was 22 days in the monitoring group versus 55 days in the standard care group. Additionally, treatment rates increased with monitoring, with pacemaker implantation rising from 4.6% to 6.8% and antiarrhythmic therapy from 7.3% to 10.8%. Importantly, the study found a 50% reduction in all-cause mortality at one year in the monitoring group.
While immediate ECG monitoring did not reduce recurrent fainting, it enabled the earlier identification of life-threatening cardiac rhythm disorders, leading to prompt treatment, reduced uncertainty, and potential prevention of avoidable deaths.
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