Implantable Loop Recorder

An implantable loop recorder is a small electrical device that can continuously record heart activity. It is often used to help find a cause for recurrent unexplained syncope when there is a strong suspicion of a heart rhythm cause but all other simple tests have been routine. It can also be used to monitor a patient’s heart rhythm after atrial fibrillation ablation procedures.

The implantable loop recorder comes in many different sizes and is generally about the size of a computer USB and sits underneath the skin. There are no wires to the heart. It allows continuous recording of the heart’s activity so that we can diagnose arrhythmias.

Insertion of an Implantable Loop Recorder is a very common procedure. It is performed under local anaesthetic with sedative medication to make you feel comfortable. The procedure takes approximately 15-20 minutes and is performed in the cardiac catheter laboratory. This is a particular room that has a patient table, X-Ray tube, ECG monitors, and other equipment. The staff in the lab will all be dressed in hospital theatre clothes and during the procedure will be wearing hats and masks.

Many ECG monitoring electrodes will be attached to your chest area. A nurse or doctor will insert an intravenous line usually into the back of your hand. This is needed as a reliable way to give you medications such as antibiotics and pain relief medications as part of the procedure.

The area is prepared with a particular sterile solution that may feel cold. You will be covered by a large sterile sheet that will partly cover your face. You will be able to look out from under the sheet to the side and a nurse will be present at all times. You will be given oxygen to breathe by a small tube that is positioned under your nostrils or by a mask that covers your face.

A small ~2cm incision is made in the chest wall. A small pocket (shaded pink) is made underneath the skin to accommodate the device. The device is inserted into the pocket and the wound is then closed with dissolvable sutures. A small scar of ~2cm will be visible initially but will fade with time.

The device can pick up the electrical activity from the heart from the outside of the chest without any wires as it sits in the tissue over the heart, just like an ECG.

Although the device is monitoring your heart rhythm continuously, it can be manually activated to record a short segment of your heart rhythm when you are experiencing symptoms. We can then use this recording to determine if your symptoms are due to an abnormal heart rhythm. Our technicians will explain to you how to manually activate your implantable loop recorder.

If you experience one of your episodes when you are back at home, please call our department and fix an appointment for device interrogation.

If you are taking anti-coagulation (blood thinning) medication eg warfarin then you will need to stop this for approximately 5 days before your procedure. Your doctor may arrange for you to have daily heparin injections after you stop the warfarin.

You will also require an ECG and blood test before the procedure. The doctor will also confirm the time you should be at the hospital for admission.

You will be required to fast for at least six hours before each of the procedures. If your procedure is in the afternoon you may have a light breakfast. If your procedure is in the morning, DO NOT EAT OR DRINK AFTER MIDNIGHT, except for sips of water to help you swallow your pills.

After the procedure, you will have some bruising and discomfort in the area of the implantable loop recorder that may persist for several weeks. This bruising can create a bluish discoloration over the upper chest and arm. This is normal.

You should avoid strenuous activities with your arm or lifting the arm above your head for 4 weeks. You should refrain from driving for 2 weeks. You should not go swimming, play golf, or bowling for 4 weeks.

A sterile dressing is left over the pacemaker for 6 days. You can carefully remove this dressing yourself on the 6th day after the procedure. At this stage, the wound is sufficiently healed to allow you to shower with the dressing removed.

You will be allowed to go home on the day of the procedure after a few hours once the sedation has worn off. You will be asked to visit our clinic approximately one month after the implant.

Usually, the discomfort and swelling from the wound settle gradually over several weeks. If the wound becomes increasingly tender reddened and swollen or you have any other concerns, you should contact us.

Implantable Loop Recorder Implantation is a very common and low-risk procedure and should a complication arise, it will be dealt with at once.

• Haematoma (large bruise) – this may occur at the insertion site. This may be uncomfortable and can take several weeks to settle.
• Infection – There is a very small chance that the device will develop an infection. Should this occur, it is usually necessary to remove the device to clear the infection.