Dr Allan Harkness

Consultant Cardiologist for Essex and Suffolk

Loop Recorder Implantation

I can arrange for you to have loop recorder implantation at Colchester Hospital or The Nash Basildon Suite at The Essex Cardiothoracic Centre.

A loop recorder is a device to monitor your heart rhythm for many years if required.

What does it involve?

Prior to the procedure, you will have an intravenous cannula (small plastic tube) inserted into a vein in your arm. This is so we can give you antibiotics before the procedure. The nurse will also take some routine observations, eg blood pressure, and do an ECG.

You will be taken into the cath-lab or operating room and asked to lie on a flat, thin bed. You will have a clip put on your finger to measure your pulse and the oxygen levels in your blood. Your blood pressure will be measured periodically.

The skin over your upper left chest will be cleaned with sterilising solution. The location for the recorder will be determined by ECG so that it is overlying your heart. You will be covered in sterile drapes. Local anaesthetic will be injected into the skin. This will sting and then go numb. You should not feel anything other than some pressure after this. A small incision will be made to the skin and a pocket fashioned to fit the device under the skin. The size of the incision is determined by which device you are having fitted. The LINQ device is just pushed in under the skin, whereas the Reveal XT needs a slightly larger pocket and is sewn into place — you will need a few dissolving stitches to close the skin with the Reveal XT but the LINQ usually just needs a steri-strip or glue.

What preparation is needed?

You will need two skin swabs to check you don’t have the skin infection “MRSA” — the nurses at the Oaks hospital can arrange this and some GPs offer this service.

I don’t insist on you being starved in preparation for the implantation but you should not have a large meal beforehand. It is very important that you take all your usually medication on the day of the implantation unless you are given specific advice by the pre-assessment team.

Please bring all your medication with you (we can take a note of this and also give you any you need during your stay). You may wish to bring a book or magazine to read before or after the procedure. If you think you may find the procedure stressful, you may wish to ask for a sedative to be given just beforehand.

How long does it take?

Implantation of a loop recorder is done as a day case procedure. The actual procedure usually takes from 5-10 minutes to do. The recovery and monitoring period in the ward is very short.

What happens after

You go to the recovery ward. The nurses will keep an eye on your wound and you can have something to eat. If you need any medication, the nurses can help you with this. They will check your pulse and blood pressure.

The cardiac physiologist will check the device can be talked to with their programmer — this is done with wireless technology. They will instruct you how to use the activating device and who to contact if you have symptoms that suggest we need to read the device’s stored ECGs.

After the procedure, the nurses can usually give you an approximate time that you will be fit to go home. They can telephone someone to arrange for you to be picked up. I don’t recommend you go home alone.

You will be invited back for a check at the device clinic in about 4-6 weeks and they will go over things with you again. Some patients choose to have ongoing monitoring done remotely over the phone rather than have to visit the clinic each time — you can discuss this with the physiologists and make your own choice.

What are the risks?

The commonest problem is some bruising around the wound. The only other risk is infection, which is very rare — any sign of redness, swelling or pain should mean you contact me straight away — you can do this through my secretary at the Oaks

What are the benefits?

Loop recorders are generally used when symptoms are severe enough to justify a little operation (for example blackouts) but too rare to be picked up on a wearable monitor. A wearable monitor can only really be tolerated for about a week so if symptoms are less frequent, it might not pick anything up.

A loop recorder can stay under your skin for a few years, depending on battery life. It records your heart beat all the time but only stores the rhythm if it detects an abnormality or if you use the activating device — this is a small box that you should carry around at all times and the physiologist will tell you how to use it. When activated, the loop recorder stores a few minutes of past ECGs as well as some of the future minutes too. This means you can activated the device when you feel palpitations but more importantly, you can activate it after you have had a faint or similar problem and it will still have picked up the ECG — it can only store a few minutes so it is important you activate it as soon as you can. Occasionally loop recorders are implanted to detect important rhythm abnormalities (eg atrial fibrillation) that we suspect you might be having but have not noticed (ie you are asymptomatic). This is an area of ongoing research, for example after stroke.