Palpitations and syncope in primary care

Palpitations are a common complaint. It is useful for the GP to determine which are benign and which are potentially life-threatening and require urgent referral.
Two cases are presented here in which the GP used 24-hour electrocardiogram (ECG) monitoring to detect a prolonged daytime sinus pause. Both patients were referred, as a consequence, for permanent pacemaker insertion.
A 24-hour ambulatory ECG monitoring machine allows the GP to reassure patients whose palpitations have a benign origin, to reduce inappropriate referrals to secondary care, and to produce a more informative referral letter.