Study of insertable cardiac monitor use in unexplained syncope patients

The Picture Study1

Reveal™ ICM Guides Diagnosis in 78% of Patients with a Recurrent Syncopal Event

The PICTURE Study investigated the effectiveness of Reveal ICM in the diagnosis of unexplained, recurrent syncope in everyday clinical practice, and helped inform current syncope guidelines.

Key Findings

570 Patients Enrolled

Physician Specialists Consulted Before ICM Insertion

Chart of specialists consulted before ICM insertion shows syncope patients moved from specialist to specialist without answers

Clinical Impact

PICTURE Study found that syncope patients:

  • Moved from specialist to specialist without answers
  • Had a median of 13 inconclusive tests before a Reveal ICM was implanted
  • 70% were hospitalized at least once for syncope and of that, one third experienced significant trauma

By using Reveal ICM earlier in the care pathway, there is the potential to reduce the number of physicians patients see.

Study Design

  • 570 patients analyzed
  • Patient eligibility: enrolled patients had recurrent unexplained syncope or pre-syncope
  • Patients received a Reveal ICM
  • Patients were followed up until the first syncopal recurrence, or for at least 1 year

Study Conclusion

A Reveal ICM should be implanted earlier rather than later in the evaluation of unexplained syncope.



Edvardsson N, Frykman V, van Mechelin R, et al. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry. Europace. February 2011;13(2):262-269.