Implantable Loop Recorder

What is an implantable loop recorder?

An implantable loop recorder (ILR) is a small device that a healthcare provider places in your chest, just beneath the skin. It monitors your heart rate and rhythm and records anything that’s abnormal. Most stay implanted for up to three years, but it may come out sooner if your provider gets the information they need. This makes it different from other ambulatory devices that you use for just a couple days or weeks.

Your cardiologist may recommend an ILR, also called an insertable cardiac monitor, to:

• Find what’s causing your heart palpitations or fainting episodes when other tests haven’t found enough information
• Diagnose AFib and other arrhythmias (abnormal heartbeats) that happen too rarely for other tests to catch
• Monitor and treat an arrhythmia you’ve already been diagnosed with
• Watch your heart’s electrical activity after a heart attack or stroke

How does an implantable loop recorder work?

A loop recorder detects your heart’s electrical activity and records changes that shouldn’t be there. The device is small and rectangular. It’s less than half an inch thick and about 1 to 2 inches long. Metal casing encloses an electrical circuit and a battery.

This device is subcutaneous, meaning it rests beneath your skin (not deep within your body). You might notice a faint outline of the loop recorder under your skin. But it shouldn’t cause any pain or discomfort.

Your loop recorder is synced with a handheld activator. You can press a button on the activator any time you have symptoms, like palpitations. This prompts the device to record and save your heart’s electrical activity at that moment and for a short time leading up to it. Using the activator when you have symptoms helps your provider match symptoms with abnormal activity.

The loop recorder also records anything abnormal, even if you don’t have symptoms. It does this automatically, without you having to do anything. It saves all this data to its memory bank (much like a USB stick). Your provider will set up the device so it sends data to them on a regular basis.

What happens before the device is implanted?

Your cardiologist will make sure a loop recorder is right for you. They’ll review your medical history and do a physical exam. They may order tests, including:

• EKG
• Echocardiogram
• Exercise stress test
• Tilt table test

If these tests don’t reveal any heart problems, but you still have symptoms, you may need a loop recorder.

Your cardiologist will tell you how to prepare for the procedure. In general, you should arrange for someone to drive you home afterward. This is because you’ll be sedated. It’s not safe to drive for 24 hours.

What can I expect during loop recorder placement?

This is an outpatient procedure, meaning you can go home the same day. You don’t need general anesthesia. But you’ll receive medicine to help you stay comfortable.

An electrophysiologist implants your loop recorder. This is a cardiologist who specializes in your heart’s electrical system. Here’s what they’ll do:

1. Give you a mild sedative (to help you relax) and a local anesthetic (so you don’t feel pain).
2. Make a small cut in your skin on the left side of your chest.
3. Create a small pocket just under your skin where the device will rest.
4. Insert the loop recorder into the pocket.
5. Close the opening in your skin with stitches or surgical glue.
6. Move a magnet over your chest to activate the device.

The procedure takes about 10 to 15 minutes.

What are the pros and cons of an implantable loop recorder?

An ILR helps you and your healthcare providers learn a lot about your heart. And putting it in is a low-risk procedure. But it’s more invasive than other tests, like an EKG or a monitor you wear outside your body. Your cardiologist will talk with you about the benefits and drawbacks before you get started.

The benefits of an ILR include:

• Long-term monitoring: An ILR can provide data for much longer than other devices. This is a huge plus. Research shows that ILRs identify more AFib cases the longer the device stays in — with three times as many cases detected at 30 months compared to six months.
• Automatic recording: A loop recorder can detect issues even when you don’t feel anything. This is helpful in lots of situations. For example, you might faint but not remember it. Or you may have AFib that doesn’t cause symptoms you notice.
• Convenience: You can go about your normal routine, including bathing and swimming. The loop recorder is hidden, and no one will see it. It also won’t get in the way as some other monitors might. This helps if you have an active job or lifestyle.

The drawbacks of an ILR include:

• Need for a procedure: A healthcare provider must implant the device under your skin.
• Risk of infection: If an infection develops near your device, you need antibiotics to treat it. You may also need the device moved to another spot in your chest.
• Risk of an allergic reaction: You may be allergic to some material in the device. In this case, you’ll need another type of monitoring device.
• Chance of a poor signal: Sometimes, the device can’t pick up electrical signals from your heart. You’ll need the device moved elsewhere in your chest if this happens.

Can a recorder damage your heart?

No. An ILR is safe and doesn’t hurt your heart. It also doesn’t change your heart rate, provide a shock or do anything to affect your heart’s activity. Instead, it simply monitors your heart’s electrical activity and records anything that’s abnormal.

What can I expect after loop recorder placement?

Most people go home right away and can return to their normal routines. Before you go home, the doctor who does your procedure will show you how to use the equipment that syncs with your device. This includes:

• A handheld activator with a button to press when you have symptoms
• An electronic transmitter that sends data to your usual cardiologist on a regular basis

You’ll also receive instructions on how to keep the small wound from the procedure clean. That area of your skin may feel sore, and you may notice bruising. This discomfort is normal and will go away in several days. Your provider will tell you how long to wait before getting the area wet.

What kind of results do you get?

A loop recorder saves graphs and numbers that show your heart’s electrical activity — including how fast or slow your heart is beating and the rhythm of those beats. The transmitter sends all this information to your cardiologist. They’ll tell you when the results are ready for you to discuss together. These results can diagnose or rule out arrhythmias and help your provider plan treatment.

When should I call my doctor?

Call your cardiologist right away if your incision site has:

• Redness or color changes
• Swelling
• Bleeding
• Pus or discharge

These can be signs of complications that require immediate care.

Why am I getting a loop recorder and not a pacemaker?

An implantable loop recorder is a diagnostic test, while a pacemaker is a treatment. If your cardiologist recommends a loop recorder, it’s because they want to learn more about your heart rate and rhythm. A loop recorder doesn’t do anything to change your heart’s electrical activity. It simply monitors and records it.

A pacemaker is different because it detects abnormal rhythms and sends electrical signals to correct them. A loop recorder can help your provider know if you need a pacemaker.

Can a loop recorder detect a heart attack?

No, it’s not meant to do that. But it can detect arrhythmias that develop as a complication of a heart attack.

A heart attack is a medical emergency. If you feel chest pain or other symptoms, don’t wait to seek help. Call 911 or your local emergency number immediately.