What is Loop Recorder Placement?
Loop recorder placement or implantation is a minor surgical procedure to place a type of heart recording or monitoring device called an implantable loop recorder (ILR) underneath the skin of your chest, overlying the heart. The device functions as an electrocardiogram (ECG), continuously recording electrical activity from your heart for up to 3 years. This can assist in detecting abnormal heart rhythms that can trigger a variety of problems such as syncope (fainting or passing out). The ILR device is similar to a pacemaker, however, one of the main differences is that the ILR does not regulate the heart rate.
Indications for Loop Recorder Placement
Loop recorder placement is typically recommended for cardiac patients who could experience heart-related symptoms such as abnormal heartbeat (arrhythmia), unexplained stroke, recurrent palpitations, seizures, fainting, dizziness, or lightheadedness. The implantable loop recorder is ideally employed in patients who go through these serious symptoms regularly but not often enough to be recorded by a 24-hour or 30-day external monitor.
An ILR can record information that a standard Holter monitor or electrocardiogram (ECG) may miss, specifically arrhythmias that are infrequent or brief. For instance, if you are experiencing fainting spells, your physician would want to know if an issue with your heart is triggering your symptoms. A standard ECG captures only your heartbeat for a few seconds or minutes. An ILR monitors your heartbeat for a much longer duration, so it is more likely to record what your heart is doing if you faint again. Information from an ILR can help your physician confirm the diagnosis and devise your treatment plan.
Working Mechanism of an Implantable Loop Recorder
An implantable loop recorder is a thin, small device about the size of a computer USB and captures the electrical activity of the heart in two ways.
- In the first way, the device gets activated based on the heart rate range set by your physician. If the heart rate falls below the lowest value set by your physician, the ILR will automatically get activated and start to record. In the same manner, if the heart rate surges over the highest value set by your physician, the ILR will also record without the patient’s awareness.
- In the second way, the ILR device records through a “patient activator” wherein a patient can initiate a recording by pushing a button on the activator. The activator can be utilized when you experience symptoms such as dizziness, lightheadedness, or skipped heartbeats. To initiate a recording, simply place the “patient activator” over the ILR and press the button. A green light will flash when the recording is successful. The recording is stored in the ILR itself. Your physician can view both the triggered and automatic events during a routine office visit using a special programmer, which looks similar to a laptop computer.
Preparation for Loop Recorder Placement
In general, preparation for a loop recorder placement may involve the following:
- Refraining from food or drink at least 4 hours before the procedure
- Informing your physician of all the medications or supplements you are taking
- Disclosing any medical conditions you have such as lung or heart disease
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Refraining from certain medications, such as blood-thinners or anti-inflammatories
- Arranging for someone to drive you home after surgery
Procedure for Loop Recorder Placement
Loop recorder placement procedure takes about 15 to 20 minutes and is performed in a cardiac catheter laboratory. This is a special room consisting of a patient table, ECG monitors, an X-Ray tube, and other items. In general, the procedure involves the following steps:
- You will be asked to lie down on the procedure table in a supine (face-up) position.
- An intravenous line is placed into your arm to administer sedatives (medication to relax you), antibiotics, and pain medicines as part of the procedure.
- The chest area, where the implant is to be placed, is thoroughly cleaned and a local anesthetic is used to numb the area.
- A small incision is made just to the left of the breastbone in the left upper chest area. A pocket is made under the skin and the ILR is placed in this pocket. Your cardiologist will program the ILR to the required settings during the procedure.
- As opposed to a pacemaker, no wires, electrodes, or leads are required for an ILR.
- The incision is closed with dissolvable sutures and covered with a bandage or dressing.
Post-Procedure Care and Recovery
Following the procedure, you will be allowed to go home on the same day after a few hours of observation once the sedation has worn off. You will be provided with pain medicines as needed to manage pain from the treatment area. You are advised to take rest for a few days and not to engage in any strenuous activities for at least a couple of weeks. You should be able to resume your normal activities in a day or two, but with certain activity restrictions. Follow-up appointments will be scheduled to monitor your progress and evaluate the readings recorded in the ILR.
Risks and Complications
Loop recorder placement is a safe procedure; however, as with any minor surgery, risks and complications may occur, such as the following:
- Pain at the site of implantation
- Hematoma (large bruising)
- Infection (might necessitate removal of the device)
- Injury to blood vessels or heart