An implantable loop recorder (ILR), also known as an insertable cardiac monitor, is a small device placed just under the skin of the chest. It continuously monitors and records the heart’s electrical activity over an extended period. It is particularly useful for detecting irregular heartbeats, or arrhythmias, that occur infrequently and might be missed by shorter-term monitoring tests. The ILR helps healthcare providers identify the cause of symptoms such as fainting, dizziness, unexplained falls, or palpitations.
Preparing for the Procedure
Before a loop recorder insertion, patients receive specific instructions to ensure a smooth process. Healthcare providers typically advise patients about medication adjustments, especially concerning blood thinners, which may need to be temporarily stopped several days prior to the procedure. Patients are often asked to fast for a few hours before the appointment, though some procedures may not require this.
Upon arrival at the facility, patients will discuss their medical history, allergies, and current medications with the medical team. They may also undergo some pre-procedure tests, such as an electrocardiogram (ECG), to assess their heart’s electrical activity. Patients usually change into a hospital gown, and the area where the device will be inserted may be cleansed or shaved to prepare the skin.
The Insertion Process
The insertion of an implantable loop recorder is a minimally invasive procedure, often performed in an outpatient setting. The area of insertion, typically the upper left side of the chest near the breastbone, is cleaned with an antiseptic solution. A local anesthetic is then administered to numb the skin.
Once the area is numb, the healthcare provider makes a small incision, usually ranging from 0.5 to 4 centimeters (about 0.2 to 1.5 inches), just under the skin. An insertion tool is used to create a small pocket beneath the skin where the device will reside. The loop recorder, which is roughly the size of a AAA battery or a USB memory stick, is then placed into this created pocket.
The device sits just beneath the skin without any wires extending into the heart. Once positioned, the incision is closed using sutures, surgical glue, or adhesive strips. The entire procedure typically takes a relatively short time, often ranging from 10 to 30 minutes, allowing most patients to return home on the same day.
After the Device is Placed
Following the insertion of a loop recorder, patients typically return home the same day with minimal recovery. Some mild pain or bruising at the insertion site is common and can be managed with over-the-counter pain medication. Healthcare providers provide specific instructions for wound care, which usually involves keeping the incision clean and dry for several days, often for 2 to 10 days, and avoiding baths or swimming during this period.
The device begins monitoring heart activity immediately and is designed to be largely unnoticeable in daily life. It continuously records the heart’s electrical signals, automatically saving data when it detects abnormal rhythms, such as those that are too fast, too slow, or irregular. Patients also receive a handheld activator or an app for their smartphone, allowing them to manually trigger a recording when they experience symptoms.
Data from the loop recorder is transmitted wirelessly to the healthcare team, often via a home monitor or a smartphone application, typically overnight. This continuous monitoring can last for an extended period, usually up to 3 to 5 years, providing a comprehensive view of the heart’s rhythm. The goal of this monitoring is to gather sufficient data to diagnose the cause of symptoms and guide appropriate treatment.
Removing the Loop Recorder
Once monitoring is complete, or sufficient diagnostic data has been collected, the loop recorder can be removed. The removal procedure is also minimally invasive and generally mirrors the insertion process. It is typically performed in an outpatient setting under local anesthesia, numbing the area to ensure patient comfort.
The healthcare provider makes a small incision over the site where the device was implanted, carefully extracts the loop recorder, and then closes the incision. The procedure usually takes about 15 to 30 minutes. Patients can typically go home the same day, with minimal recovery time required after the removal.