The Implantable Medtronic Cardiac Loop Recorder: A Personal Experience
Wearing A Holter Monitor
My Cardiac Issue Story in a Nutshell
About ten years ago I had a very unusual experience in which I fell asleep sitting up in a chair, while my three children played nearby in our above-ground pool.
The last thing I remember was the joyful sounds of chatter and splatter of water as they played. Hours later, I woke suddenly to unnerving quiet and the sun going down, displaying a beautiful sunset. Why was that unnerving? I am not the type to just fall asleep that easily, and I had never fallen asleep sitting up in a chair....until that day.
My children thought that I was just taking a well-deserved nap, and so decided to leave me sleeping while they came inside to clean-up from their swimming. None of them were worried that something might be wrong.
I headed to the Emergency Room, where it was determined, after several hours, that I had an arrythmia. I was extremely exhausted, and I was told that due to the extremely fast heartbeat that I exhibited when I arrived, it was like running a marathon, which would explain the fatigue. I was sent to my doctor and a cardiologist the next day.
I would often feel a faint fluttering in my chest, but no doctor was able to detect before she fainted, and if she coughed she could sometimes stop the episode, but this ER visit provided hope that maybe someone would finally figure out what was going on.
After meeting with my doctor, and having another ECG done, test results came back normal, but I knew something was going on. Wearing a holter monitor was suggested The monitoring revealed a rapid heartbeat of 248 beats per minute on occasion. During this period I woke suddenly to investigate the rattling that I heard under the bed. I just knew that there was a rattle snake under the bed. It was revealed that the rapid heartbeat of 248 beats per minute coincided with the rattle that I heard "under the bed."
I was tried on several medications, until my cardiologist suggested that I think about getting an implantable cardiac monitor. After much discussion, and being able to see an actual device, I went ahead with the surgery. I did not experience any major complications from the implant procedure. I did have some mild reaction to the surgical tape and bandage at the surgical site.
Now, whenever I experience an "event," I immediately place the Patient Assistant over the device site and press the button. Enough of these episodes have given my cardiologist enough information to determine SVT (super-ventricular tachycardia). I am still being monitored for these episodes. He prescribed medication to control the condition, but the arrhythmia persists.
In about two months, it will be a year since I have had the implant, but we have already discussed having an EP (Electrophysiology) study done.
Well that's my story in a nutshell. You will hear more about it in my video posted at the end of this article.
What Is The Implantable Cardiac Loop Recorder?
The loop recorder can be referred to as an:
- insertable cardiac monitor
- insertable loop recorder (ILR)
- insertable cardiac.
Implantable loop recorders (ILRs) are:
- small lead-less boxes
- about 6.5-9 mL in volume (the size of a standard memory stick)
- have 2 self-contained electrodes that are implanted subcutaneously under local anesthesia, typically in a left parasternal location
- Current ILR devices have a battery life of up to 3 years.
The implantable cardiac device is a device about the size of a flash drive (maybe a little smaller) that continuously monitors heart rhythms and records them either automatically or when you use a hand-held patient assistant. The hand-held assistant allows the patient to mark the occurrence of an episode so that the Cardiologist will be aware of when one is felt.
The ILR device:
- makes a record of your electrocardiogram (ECG or EKG) when you have fast or slow heartbeats
- monitors your heart continuously based on what the doctor programs
- when you feel dizzy or like you want to faint
- can be used to see how you respond to medicines..
The Implantable Cardiac Loop Recorder
How Does The Reveal Implantable Loop Recorder Work?
The ILR continuously monitors the rate and rhythm of the heart.
It works much like a black box in an airplane, whereby
- vital information is recorded and can be played back later for detailed analysis
- it can continuously record the heart’s rhythm and rate for up to 3 years
- it can help to determine if unexplained transient symptoms are related to a heart rhythm problem in up to 88 percent of cases, a diagnostic yield much higher than traditional methods. (Source: American Journal of Cardiology, 1998)
To store the electrocardiogram (ECG) at the time of the episode, I simply place a hand-held, pager-sized activator, called the Patient Assistant over the Reveal ILR site after or during an episode, and press a button. The button will be blue, and when the episode has been recorded, it changes to green.
If I am unconscious, a family member or friend also can be the one to place the activator over the device to save the information. Later, a physician analyzes the stored information and determines whether the episode was caused by an abnormal heart rhythm.
Using The Patient Assistant
When Would An Implantable Cardiac Monitor Be Recommended?
An ILR would be considered in the following instances:
- For evaluation of recurrent unexplained episodes of pre-syncope, syncope, seizures, palpitations, or dizziness
- A cardiac arrhythmia is suspected as the cause of the symptoms
- For persons with heart failure, prior myocardial infarction or significant ECG abnormalities
- Noninvasive ambulatory monitoring, consisting of 30-day pre-symptom external loop recordings or MCT (Mobile Cardiovascular Telemetry), fails to establish a definitive diagnosis
- For persons without heart failure, prior myocardial infarction or significant ECG abnormalities, symptoms occur so infrequently and unpredictably (less frequently than once per month) that noninvasive ambulatory monitoring (MCT or external loop recorders) are unlikely to capture a diagnostic ECG.
- For evaluation of members with suspected atrial fibrillation as a cause of cryptogenic stroke who have had a non-diagnostic Holter monitor.
Placement Of The Device
The Surgery: How Is The Cardiac Loop Recorder Implanted?
Placement of an implantable loop recorder (ILR):
- can be performed in any standard procedure suite
- is typically inserted in the left parasternal region.
Prophylactic antibiotics are administered intravenously prior to the incision.
Under sterile conditions the creation of a small subcutaneous pocket using local anesthesia is required.
A mild anxiolytic and/or analgesic can also be administered to enhance patient comfort.
Implanting the ILR
- takes about 15 to 20 minutes
- can be done under a local anesthetic
The physician makes an incision about 2 centimeters in length, creating a pocket the same size and shape as the ILR device, about the size of a pack of gum.
Once the device is inserted in the pocket, it is programmed to record the ECG during an episode.
When heart activity is recorded during an actual episode and the physician is satisfied that heart rhythm-related causes can be ruled in or out, the device can be removed.
After my surgery
My Ticker Is Always Being Watched!
Having a loop monitor implanted is like being on a leash, and being under 24 hour surveillance!!!!!
WARNING: 24 hour surveillance and recording by Linq Reveal implanted Cardiac Monitor. By having this recorder implanted you agree to have EVERYTHING about your heart monitored. Yes, you have to even give us every reason why your heart rate may have increased. Why exactly are you rock climbing?
It's a good thing, though. My ticker is always being watched. Gotta love technology!
What Is This Device Telling The Cardiologist?
- If the medicines are working.
- If a pacemaker or an implantable cardioverter defibrillator (ICD) is working properly.
- Why you have symptoms such as chest pain, dizziness, faintness or the feeling that your heart is racing or skipping a beat.
- If your heart is getting enough oxygen to meet its needs.
- If you're at risk for atrial fibrillation
An Actual Surgery Showing The Implant Procedure
What Are The Treatment Options If The Cause Is Determined To Be Heart-Related?
When the cause of the episodes is properly determined, it usually can be treated.
- If the episodes are caused by an abnormal heart rhythm, treatment options include medication
- a pacemaker
- implantable cardioverter defibrillator (ICD),
- catheter ablation.
After these treatments, patients can often resume normal activities without fear of suffering another episode. Such treatments not only may eliminate the episodes, but may also correct the underlying cause, which may result in better overall health and improved quality of life for patients.
What's Next For Me?
In a few weeks I will meet with my cardiologist to discuss the Cardiac Ablation procedure, and possible implantation of a pacemaker. It is unclear at this point if the loop recorder will be removed or will be allowed to stay in to continue to monitor me long-term.
Catheter ablation , also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s the least invasive option. My Cardiologist will put a thin, flexible tube into a blood vessel in leg. Then, it's guided to my heart.
This procedure destroys the tissue that may be causing the heartbeat to get off course. This creates scar tissue inside the heart’s chambers. This scar tissue is a good thing. It will help the heartbeat stay in rhythm.
Your doctor uses heat, cold, or radio energy to scar some tissue inside your heart, where the irregular beats are triggered. The treated tissue helps get your heartbeat regular again.
The Ablation Procedure
Have you had an implantable device related to the heart?
Questions & Answers
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