What is loop recorder implantation?

An implantable loop recorder, or ILR, is a heart recording device that is implanted in the body underneath the chest skin. It has several uses. The most common ones include looking for causes of fainting, palpitations, very fast or slow heartbeats, and hidden rhythms that can cause strokes. During a loop recorder implantation, your heart healthcare provider (cardiologist) does a minor procedure. He or she places the small device under your skin, on your chest wall, overlying the heart. The machine works as an electrocardiogram (ECG), continuously picking up electrical signal from your heart. This can help find abnormal heart rhythms that can cause a number of problems such as fainting.

Normally, a special group of cells begin the electrical signal to start your heartbeat. These cells are in the sinoatrial (SA) node. This node is in the right atrium, the upper right chamber of your heart. The signal quickly travels down your heart’s conducting system to the ventricles. These are the 2 lower chambers of your heart. As it travels, the signal triggers nearby parts of your heart to contract. This helps your heart pump blood in a coordinated way.

Any disruptions to this signaling pathway may result in heart rhythm problems. These might cause a number of problems, such as fainting and palpitations. An abnormal heart rhythm (arrhythmia) may make your heart unable to pump as much blood as needed. The temporarily reduced blood to your brain is what causes you to faint. When the rhythm returns to normal, you normally regain consciousness.

Each heart rhythm problem may need its own treatment. It’s important to find out what kind of problem you may have, if any. An implantable loop recorder continuously records information about your electrical activity, similar to an ECG. However, an implantable loop recorder can record heart rhythm for up to 3 years. It is continuously looping its memory and has automatic triggers to store recordings. It can also be patient activated to store recordings as well.  If you fainted due to an arrhythmia, the machine records this information before, during, and after the fainting. Then a healthcare provider can look at the recordings to figure out the cause.

Why might I need a loop recorder implanted?

You might need a loop recorder if you have fainting episodes or palpitations, and other tests have not yet given you any answers. Repeated fainting can have a negative effect on your physical and emotional health. Also, certain kinds of fainting greatly increase your chance for sudden death. These fainting episodes require diagnosis and treatment as soon as possible. Once you are diagnosed, you may need a pacemaker or an implantable cardioverter-defibrillator (ICDs). These could save your life. You might also need a loop recorder if your healthcare provider wants to look for very fast or slow heartbeats. These abnormal heartbeats can cause palpitations, or even lead to strokes.

If you have a problem with fainting, your healthcare provider will look at various causes. Only certain kinds of fainting are due to abnormal heart rhythms. Your healthcare provider will probably start with basic tests like an electrocardiogram (ECG). This records your heart rhythm only for a few seconds, however. So, your healthcare provider may not be able to analyze the specific rhythm problem that causes your fainting. He or she might have tried other sorts of tests, like Holter monitoring, tilt-table testing, or electrophysiologic studies of your heart.

Loop recorder implantation is often helpful if other tests haven’t found the cause. Your healthcare provider is more likely to recommend it if your heart is a likely cause of your fainting. This is more common in the elderly. It is also more common in people with other heart problems. You are also more likely to need loop recorder implantation if you are fainting frequently, but not enough for other kinds of heart rhythm monitoring to detect your fainting. Because the loop recorder records for up to 3 years, your healthcare provider should eventually be able to analyze your heart rhythms during a fainting episode.

You also might need a loop recorder if you are an older adult with unexplained falls. Healthcare providers sometimes use it in people believed to have epilepsy who have not responded to medicine. In both cases, the recorder can determine whether an abnormal rhythm is the problem.

What are the risks for loop recorder implantation?

Most people have the procedure without any problems. However, sometimes problems happen. These might include:

• Bleeding or bruising
• Infection (might require device removal)
• Damage to your heart or blood vessels
• Mild pain at your implantation site

Your own risks will depend on your age, your other medical conditions, and other factors. Ask your healthcare provider about any risks of the procedure for you.

How do I prepare for a loop recorder implantation?

Talk with your healthcare provider about what you should do to prepare for your procedure. You may need to avoid eating or drinking anything before the midnight before your procedure. Follow your healthcare provider’s instructions about what medicines to take before the procedure. Don’t stop taking any medicine unless your provider tells you to do so. He or she might order tests before the procedure, like an ECG.

What happens during a loop recorder implantation?

Ask your healthcare provider about what to expect during your procedure. Normally, you can expect the following:

• You may be given medicine to help you relax.
• A local anesthetic will be put on your skin to numb it.
• Your healthcare provider will make a small incision in your skin. This is usually done in the left upper chest.
• Your healthcare provider will create a small pocket under your skin. He or she will place the loop recorder in this pocket. The machine is about the size of a flat AA battery.
• Your incision will be closed with sutures. A bandage will be put on the area.

What happens after a loop recorder implantation?

Ask your healthcare provider about what to expect after your procedure. In most cases:

• You will be able to go home the day of the procedure.
• You can ask for pain medicine if you need it.
• You will need someone to drive you home after the procedure.
• You can return to normal after the procedure. But you may want to rest.
• Tell your healthcare provider if you have bleeding or swelling at the insertion site.

All loop recorders come programmed to record certain fast and slow heart rates. However, they also come with a handheld activator that tells the loop recorder to save the signals collected over a certain period of time. This is important because it can also help explain if a fast or slow heartbeat is not what is causing your problems. Someone will make sure you know how to use your activator before you go home.

Talk with your heart healthcare provider first if another healthcare provider wants you to get an MRI test. It may cause your device to display a false reading.

You may keep your loop recorder for up to 2 or 3 years. When you no longer need it, you will need to have it removed in a similar procedure.

 

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Implantable loop recorder

An implantable loop recorder is a type of heart-monitoring device that records your heart rhythm continuously for up to three years. It records the electrical signals of your heart and allows remote monitoring by way of a small device inserted just beneath the skin of the chest.

Why it's done

An implantable loop recorder can help answer questions about your heart that other heart-monitoring devices don't provide. It allows for long-term heart rhythm monitoring. It can capture information that a standard electrocardiogram (ECG or EKG) or Holter monitor misses because some heart rhythm abnormalities occur infrequently.

For example, if you have a standard ECG to help figure out why you're having fainting spells, it will only record any related heart rhythm abnormalities during the few minutes of the monitoring period — usually about five minutes. Because an implantable loop recorder monitors your heart signals for a much longer time, it's more likely to capture what your heart is doing during your next fainting spell. This information may help your doctor make a definite diagnosis and develop a treatment plan.

Implantable loop recorders are one of the newer heart-monitoring devices. Researchers have evaluated their safety and benefit over the last 10 years. A study of 579 people with fainting spells showed that implantable loop recorders had a higher rate of diagnosis of heart rhythm problems than did other monitoring devices.

Researchers also examined the value of implantable loop recorders in people who had a stroke. Long-term heart monitoring uncovered heart rhythm problems that caused the stroke better than 24-hour monitoring did. Doctors used these results to guide treatment with blood-thinning drugs (anti-coagulation therapy) to prevent another stroke.

What you can expect

You will need to undergo a minor surgical procedure to place the implantable loop recorder. Risks of the procedure include infection or a reaction to the device that causes redness at the incision site.

Before the procedure

You don't need to do anything special to prepare for this procedure.

During the procedure

The procedure to insert the heart monitor is usually done in a doctor's office, with a local anesthetic. Your doctor makes a tiny incision, inserts the device, which is smaller than a key or a thumb drive, and closes the incision. The device stays in place for up to three years.

After the procedure

The procedure to insert an implantable loop recorder has some risk because it involves minor surgery. Your care team will advise you to watch your incision for signs of infection and, perhaps, to limit activities until the wound heals.

The device records the electrical impulses of your heart and transmits them automatically to your doctor by way of the internet and wireless technology. All you need to do is keep the transmission monitor your doctor gives you beside your bed. Transmissions occur while you're asleep. You can also activate the data transmission process yourself. In addition, your doctor may ask you to keep a diary of your symptoms.

Your doctor will interpret the results of your test and call you if he or she has any concerns. You'll likely need to see your doctor once or twice a year for routine checkups while the device is in place.

An implantable loop recorder is invisible and doesn't interfere with your daily activities. It has no patches or wires, and you don't have to worry about getting the device wet while bathing or swimming. These devices are supposed to be safe for use during a medical imaging procedure called magnetic resonance imaging (MRI), but let your doctor know about your implant before you schedule such a test.

It's also possible an implantable loop recorder might set off metal detectors, for example, at an airport. Your doctor can provide you with a device identification card to carry with you for such situations.