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.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure