85y male, 24hr holter after syncope episode detects persistent multiple skipped beats per min but no av block. place a pacemaker or continued monitor?

Monitor: There does not appear to be an indication for a pacemaker at this time.

Longer monitor?: 24 Hours is a fairly short time to monitor. When I evaluate syncope patients we often settle in for a rather longer period of monitoring. That ranges from days to weeks to months, depending upon the individual circumstances. If someone's heart stops for 4 seconds, but it only happens once every week or two, 24 hours may not be enough to catch it.