Background: In about a third of cases of recurrent syncope a diagnosis cannot be established despite extensive cardiovascular and neurologic testing. In patients without underlying heart disease the sensitivity of conventional diagnostic testing is low.
Case report: A 33-year-old male patient underwent implantation of a loop recorder (Reveal) after negative neurological and cardiovascular testing. One month after implantation sinus node arrest could be documented during a presyncope. The patient underwent pacemaker implantation and remains asymptomatic since then.
Conclusion: In patients with syncope and a negative conventional diagnostic workup the implantable loop recorder is a helpful and cost-effective diagnostic tool.