Implantable Loop Recorder: Paroxysmal AFib Monitoring
I began having AFib episodes seven years ago. Although experiencing an irregular heartbeat is pretty scary stuff, I have had only three episodes in those seven years. I have paroxysmal AFib, which means I have "episodes" of AFib that last for sometimes only a few hours, sometimes for a day or so. Mine have always reversed with medication. Some people have to have their hearts "shocked" to get them to return to normal sinus rhythm. I have not had that happen—yet. Before I go further, let me explain what paroxysmal AFib is. To begin, it is much more common than most people understand. According to the American Heart Association, 2.7 million Americans have AFib. I am far from alone.
Now, what is AFib? According to the American Heart Association, normally, your heart contracts and relaxes to a regular beat. In atrial fibrillation, when you experience an irregular heartbeat, the upper chambers of the heart (the atria) beat irregularly (quiver) instead of beating effectively to move blood into the ventricles. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results. About 15–20 percent of people who have strokes have this heart arrhythmia. This clot risk is why patients with this condition are put on blood thinners.
My doctor has allowed me to stay on a low-dose aspirin as a blood thinner because my episodes have been few and far between. Before the one I had in October, I had gone three years without one. I take 25 milligrams of metoprolol twice a day to regulate my pulse rate/heartbeat and help reduce the risk of stroke.
I've inserted the photo because I want this to be a "personal" article for those who may be anticipating having a loop recorder implanted. I'm just a normal 71-year-old woman from Louisiana. I lead a perfectly normal life. We made a long trip this past summer. I walked at least 2 miles a day with no problem. Do not think AFib will change your life forever. You can continue to do the things you like to do as far as exercise goes.
I am fortunate that I have symptomatic AFib. When I say that, I mean I am very aware when my heart goes out of rhythm and into AFib. My heart pounds in an erratic way and feels as though it's beating out of my chest. It's very uncomfortable and scary. However, I am one of the fortunate ones. Many people, my sister included, have AFib that manifests no symptoms. They do not feel anything unusual about their heartbeat. It is particularly dangerous for those who don't realize they have paroxysmal or any other sort of AFib because leaving the heart out of rhythm for 24 hours without being on blood thinners poses a risk of stroke. Many people who have AFib take blood thinners rather than aspirin as I do. The low dose aspirin I take keeps the blood thinned, preventing the formation of clots. My doctor has told me that when I am 75, I will need to begin to take a blood thinner because age increases my risk of stroke.
PA, Physician's Assistant
The Loop Recorder
After I recently had an episode of AFib, I got a notice to see my arrhythmia doctor. When I attempted to make the appointment, he was booked up, as often happens, so I saw his physician's assistant, who is also personable, capable, etc. We talked for a while and during the discussion, she brought up the implantable loop recorder. I was fascinated with the idea and asked her how involved it was to implant the recorder. She said, "It takes about five minutes. The area on the chest is deadened, then, the doctor makes a small cut with a scalpel and pushes the implant in and you're done."
I was totally sold on the idea. In between episodes of AFib, I have had times when I feel like my heart is skipping beats, beating too rapidly, etc. I liked the idea of being constantly monitored, which this implant would allow. Once it is inserted, the person wearing it keeps a monitor that looks very much like a phone by their bedside. It records data from midnight until 6:00 AM. If there is anything concerning, the techs who monitor the devices will see it during their daily review. If not, the information is reviewed at the end of each month, even if nothing untoward happens during the month.
The PA spoke to my doctor and he was in favor of the monitor. We set up an appointment for the procedure to be done. They told me there would be no anesthesia, although the procedure would be done in a hospital. A nurse would give me shots to deaden the area around where the implant would go. I wasn't worried about it at all, having had a couple of needle biopsies of the breast that were totally painless. I was ready.
The Day of the Procedure
My husband went with me to have the procedure done. They took us back to a small room. My doctor came in and said hi and told us he had another procedure he had to do first, then would get to me. When he was ready, my husband went to the waiting room, and I was taken back to a room, introduced to the two nurses who would be assisting. My chest was scrubbed with antiseptic, then they made a tent of a plastic sheet with which they covered my head. Now I couldn't see. I realized it was to keep me from breathing germs on the site they were going to cut open, but it was disconcerting, nonetheless.
I could hear my doctor's voice as he walked in, and he began to talk to me, which he pretty much continued to do throughout the procedure. I would not say that the procedure was painless. I don't know whether he injected the area to deaden it or one of the nurses did, but it stung and hurt quite a bit. Almost immediately after the shots of lidocaine, I felt tremendous pressure as he pushed the device into the small cut he had made in my chest. I didn't feel the cut, thanks to the lidocaine they injected. The "pushing" of the device was not painful, just a lot of pressure. When I asked if they were through, they said they had to test the device to see if it was recording. It was and thank God for it because I truly didn't want to go through it all again. Let me clarify: I was expecting something akin to the needle biopsy, which was a 1 on the pain scale and I got something closer to a 5. It wasn't terrible. I just wasn't ready for it. I would definitely do it again.
Another thing I appreciate about the implant is that I can travel with it. We went to our cabin in Arkansas recently and it worked fine. It had to search occasionally for a cell tower -- it works off the cell towers -- but it did work. Peace of mind is priceless.
I went back today for a checkup of the device. The women who run that department told me they had looked at all the information recorded on the loop recorder and it was all normal. There is a small hand-held monitor that accompanies the monitor that sits at my bedside. If I hold the smaller monitor over the implant and push a button, it records whatever is going on at that moment with my heart. They said everything I recorded was normal and not to record anything except if I thought I was in AFib or something else serious. That was when I learned that the "missed heartbeats," rapid heartbeats and breathlessness I experience sometimes are nothing serious.
The implant lasts for three years, then the battery has to be changed. The loop recorder has given me peace of mind. Before I had it, I wore a monitor with leads that I had to replace with fresh ones after my shower every night for a month out of each year. It was annoying and cumbersome and hard to hide. The implant eliminates the need for that monitor. I know that anything not quite right will be picked up when the data is reviewed. I recommend it to anyone who needs monitoring.
As far as discomfort, I truly do not ever feel the implant. I don't even know it's there unless I think of it. That part is perfect. Technology is grand, isn't it? I truly don't understand that much of it, but when I think of my mom complaining of her pounding heart, I wish the technology had existed in 1950.
If medications and cardioversion (shocking of the heart) do not work to keep your AFib under control, your doctor may recommend an ablation procedure. This is usually done if your AFib symptoms are serious enough to keep you from your daily activities. There are two types of ablation procedures, catheter ablation, and surgical ablation. I have never been in a situation to learn more about them, therefore, I won't write about them here. I read somewhere that the people who know little about an actual surgical procedure fare much better than those who "study up" and know everything that's going to happen. I'm going to remember that and steer clear of becoming overeducated, especially since I'm not there yet! Just remember that if you develop arrhythmia (an irregular heartbeat) there are many options open to you. It's not the end of anything, even your peace of mind, unless you allow it to be.
For More Information
- Cardiac Ablation: Types of Ablation for Atrial Fibrillation
Find out from WebMD about the different types of this procedure that are used to treat atrial fibrillation. Get information on how they work to fix an irregular heartbeat and who should get ablation as a treatment.
- Atrial fibrillation - Symptoms and causes - Mayo Clinic
Atrial fibrillation — Comprehensive overview covers symptoms, causes and treatment of this common heart disorder.
- American Heart Association - Building healthier lives, free of cardiovascular diseases and stroke.
Learn more about the American Heart Association's efforts to reduce death caused by heart disease and stroke. Also learn about cardiovascular conditions, ECC and CPR, donating, heart disease information for healthcare professionals, caregivers, and e
Questions & Answers
© 2018 Sue Pratt