Syncope is a common disorder with a lifetime prevalence of about 40%. Implantable cardiac electronic devices, including implantable loop recorders (ILR) and
implantable cardioverter-defibrillators (ICD), are well established in
syncope management. However, despite the successful use of ILR and ICD, diagnosis and
therapy still remain challenging in many patients due to the complex hemodynamic interplay of cardiac and vascular adaptations during impending
syncopes. Wearable sensors might overcome some limitations, including misdiagnosis and inappropriate
defibrillator shocks, because a variety of physiological measures can now be easily acquired by a single non-invasive device at high signal quality. In neurally-mediated
syncope (NMS), which is the most common cause of
syncope, advanced signal processing methodologies paved the way to develop devices for early
syncope detection. In contrast to the relatively benign NMS, in
arrhythmia-related
syncopes immediate therapeutical intervention, predominantly by electrical defibrillation, is often mandatory. However, in patients with a transient risk of
arrhythmia-related
syncope, limitations of ICD
therapy might outweigh their potential therapeutic benefits. In this context the wearable cardioverter-
defibrillator offers alternative therapeutical options for some high-risk patients. Herein, we review recent evidence demonstrating that wearable sensors might be useful to overcome some limitations of implantable devices in
syncope management.