WHAT IS AN IMPLANTABLE LOOP RECORDER?
The implantable loop recorder (ILR) is a small device which is implanted just under the skin of the chest to the left of your breastbone. The ILR has the ability to record the electrical activity of the heart in two ways. First, it is activated according to heart rate ranges set on the device by your physician. If the heart rate drops below the lowest value set, the ILR will automatically start to record. In the same way, if the heart rate rises over the highest value set, the ILR will also record without the patient’s knowledge. The second way it records is through a “patient activator” whereby you can trigger a recording by pushing a button on the activator. The activator can be used when you experience symptoms such as skipped beats, lightheadedness, or dizziness. To start a recording, simply place the patient activator over the ILR and press the button. A green light will flash when recording is successful. The recording is stored in the ILR itself. Your physician can view both the automatic and triggered events during a routine office visit using a special programmer, which looks similar to a laptop computer.
PREPARATION FOR LOOP RECORDER IMPLANT
Prior to your procedure, we may request tests, such as an electrocardiogram (ECG) and blood tests. We will review all medications you are taking, and give you any special instructions concerning them. You’ll be told where and when to report for your implantation of a loop monitor (unless you’re in the hospital) and what to do before you arrive. Generally, you’ll be asked not to eat or drink anything after midnight the evening before your procedure (except sips of water to swallow your pills).
Just before your procedure, we will discuss your loop monitor insertion — its purpose, benefits, and potential risks. The insertion of a loop monitor is a common, very low-risk surgical procedure with a very small risk of complications. These might include infection, bleeding, and/or bruising. Although the rate of complications is very low, you’ll be asked to sign a routine consent form. This is a good time to ask questions or talk about any concerns you may have.
Before your procedure, an intravenous line (IV) will be inserted in your arm to administer any medications. The area where the loop monitor will be inserted will be washed with an antiseptic soap and shaved. You’ll be covered with sterile drapes. You’ll be awake through the procedure, but will be given a sedative to help you relax and make you drowsy.
The procedure room personnel, who have been trained specifically in the electrical activity of the heart, will be wearing surgical hats and masks to assure that the environment is kept as clean as possible. Your ECG, heart rate, blood pressure, and oxygen level will be monitored throughout the procedure.
A local anesthetic will be injected under the skin to numb the site where the loop monitor will be implanted in the upper part of the chest. Then the electrophysiologist will make an incision about 2 cm. in length (3/4 of an inch), creating a pocket the same size and shape as the Insertable Loop Recorder device. Once the device is inserted in the pocket, it is programmed to record the ECG during a fainting episode. Then the incision will be closed with dissolvable stitches and a small bandage applied.
During the procedure you may feel some pushing and tugging on your skin. However, you should feel very little, if any, discomfort overall. The procedure usually lasts approximately one and one-half hours.
After the procedure, you’ll be taken to a hospital room or a recovery area. You’ll be discharged to home in a few hours. You may feel some discomfort in the incision area when the local anesthetic wears off.
Before you leave the hospital, you’ll be given detailed instructions about caring for your incision site. You’ll also be told what signs and symptoms to report, and you’ll be given a follow-up plan. You should arrange ahead of time for someone to drive you home.
HOW DOES THE INSERTABLE LOOP MONITOR WORK?
The Insertable Loop Recorder continuously monitors the rate and rhythm of the heart. Heart rhythm information is recorded during the actual fainting episode and can be played back later for detailed analysis. The Insertable Loop Recorder can continuously record the heart’s rate and rhythm for up to 14 months.
To capture and store the electrocardiogram (ECG) as it occurred at the time of the fainting episode, you place a hand-held, pager-sized Activator over the Insertable Loop Recorder after waking from an episode, and presses a button. A family member or friend also can be the one to place the Activator over the patient’s device to save the information. It is important for the patient to keep the Activator handy at all times (clipped to the clothes or looped over a belt). Later, a physician analyzes the stored information and determines whether the fainting episode was caused by an abnormal heart rhythm. Once the physician determines this, the device is removed and either treatment is begun or the patient is referred to other specialists.
Your loop monitor will help determine the cause of your palpitations or dizzy/fainting episodes. Be sure you understand your follow-up plan and keep all appointments for exams and follow-up tests. Follow your instructions, don’t hesitate to talk about your concerns, and immediately report any new symptoms.
As always, if you have any questions, be sure to call our office at 602-456 2342.