Does an Implantable Loop Recorder Help with AFib?

What is an Implantable Loop Recorder?

Implantable loop recorders, also called implantable cardiac monitors, are very small devices that go underneath your skin to monitor your heart rhythm. Many people who have atrial fibrillation have worn external monitors on their skin such as a 24-hour Holter monitor or a 30-day external monitor from your doctor’s office. However, managing atrial fibrillation is a long-term condition that may require long-term monitoring.

When patients are wearing a 24-hour or a 30-day monitor, what happens when if a patient gets symptoms after that monitoring period is over? If the patient is no longer wearing that external monitor, it can be very difficult for your doctor to know what it is that you’re experiencing. While wearing a 30-day monitor, it is possible that you never have any episodes or symptoms for your doctor to identify what it is that you are experiencing. Fortunately, now there are several great options for long-term monitoring , such as implantable loop recorders.

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Implantable loop recorders are small recording devices that go underneath your skin. These are implanted underneath your skin in a procedure that typically only lasts a few minutes. The typical size of a commonly used loop recorder, the Medtronic Linq, is 7mm in width, 45 mm in length, and 4 mm in thickness. The size of a monitor is similar to a regular sized paperclip, but slightly thicker. The usual battery life of a loop recorder is 3 years, although it may not be necessary to have the monitor implanted for the entire duration of the 3 years of battery life.

Loop Recorder Implant Procedure

The implant procedure typically takes less than 10 minutes to put in. The procedure involves making a cut in your skin in your left side of your chest near your heart, the cut is about the size of a fingertip. The loop recorder monitor then gets pushed underneath your skin, right above where your heart is positioned. Again, usually it only takes a few minutes to put in, the incision itself is usually closed with either skin glue or a few small sutures. Patients then get a bandage put on, and then you go typically home.

These monitors are like the heart monitors that you may have worn in your doctor’s office, except it’s underneath your skin. You don’t have to actually wear anything and you can go and do all your normal activities. These devices have a battery life that typically lasts for three years. It can give your doctor a lot of information about how a person’s atrial fibrillation is doing.

What is a Loop Recorder Used For?

There are several reasons why these loop recorders could be beneficial to some patients. One reason would be for people who have very severe sudden symptoms. If you have severe sudden symptoms that are infrequent this recorder is something that could help your doctor to detect what is happening with your heart rhythm during your symptoms.

Another useful feature of these devices is for people who may have sudden dizziness episodes or even passing out in association with their AFib. Passing out can be very sudden and happen without any warning signs. The difficult part about management of passing out is that unless you actually catch an episode while it is happening, it’s hard for your doctor to figure out if that passing out or dizziness is related to either your AFib or a slow heart rate, and how to better manage or prevent it.

Another good feature of these monitors is for people who have had a stroke where it was not certain why a patient had a stroke. It’s called a cryptogenic stroke. For people who have had a stroke and it’s not clear why the stroke happened, a common reason could be undiagnosed atrial fibrillation. These monitors when placed can help detect previously undetected atrial fibrillation and help place patients on the correct treatment plans to prevent future strokes.

Lastly, another important function for these devices is for the management of someone’s atrial fibrillation. There are many people out there who can’t tell that they’re in atrial fibrillation at all. Although there are many patients that can tell right away, there’re are many people do not notice AFib, or they have very subtle symptoms when they’re in atrial fibrillation. This device can help your doctor’s office better gauge how a person’s atrial fibrillation is doing.

With the assistance of implantable monitors, I’ve been able to detect AFib or AFib progression much sooner than waiting for the patient to develop symptoms. I’ve had many patients that I have had to call into the office because this device has told me that they’ve been consistently in atrial fibrillation for two weeks or a month for example. Even if a patient has no symptoms at that time, I can bring them into the office to discuss treatment options.

Another benefit of these implantable monitors is that they send routine reports over to your doctors office. Usually they send a monthly report, which is usually sent through either a smartphone or a small wireless home monitor that you have at your house. These implantable monitors have a hidden antenna on it that then transmits the data over to either your smartphone or to the home monitor, which then relays the information to your doctors office.

There are a several different brands of implantable monitors available right now. The most commonly implanted monitors are the Medtronic Linq as well as the Abbott Confirm Rx. Both are excellent loop recorders and I use both of them on my patients.

Frequently Asked Questions about Loop Recorders:

Is a Loop Recorder Safe?

A loop recorder implant procedure is a very quick procedure and is usually very safe. It can usually be safely placed even on patients that take prescription blood thinners or have multiple medical conditions. Since the device is very superficial, the risk of serious infection related to the device implantation procedure is also very low.

Is a Loop Recorder a Pacemaker?

A loop recorder is not a pacemaker. It can not affect the speed of the heart or pace the heart in any way. It is simply a recorder that documents what is happening inside your heart in regards to slow or fast heart rates, or episodes of atrial fibrillation. However, in some circumstances, the data provided by the loop recorder may help your doctor recommend a pacemaker if very slow heart rates or pauses are recorded.

How Do They Remove Loop Recorder?

A loop recorder will usually be removed under a variety of conditions. The device may be removed at a 3 year period when the battery life is ending. However, in many cases it is not necessary to have the device implanted for an entire 3 years. If the cause for cardiac symptoms has been addressed and treated, then the loop recorder may be removed prior to the end of the 3 year battery life. I have had several patients who only had a loop recorder for a few months because the cause of symptoms was identified and treated.

Removing a loop recorder is also a relatively simple procedure that lasts less then 20 minutes. The small incision above the loop recorder is reopened, then the loop recorder is usually removed using a small tool, like a small forceps. The incision is then cleaned and lastly closed with either sutures or a skin glue. Patients usually quickly go home after the procedure.

Can a Loop Recorder Detect a Heart Attack?

A loop recorder is not designed to detect a heart attack. It only records rhythm abnormalities, such as; a slow or fast heart rate, or an irregular heart rate such as atrial fibrillation.

Can You Shower with a Loop Recorder?

You will likely be unable to shower for a few days after a loop recorder is placed until the wound from the procedure is well healed. However, a few days after the procedure your doctor will likely give you the clearance to resume normal activities including showers. Long-term, the goal of a loop recorder is to allow you to maintain your normal activities with the security of a continuous heart monitor.

Does Medicare Pay for a Loop Recorder?

These implantable monitors are typically covered by insurance including Medicare. But always discuss with your doctor whether the implant procedure or the follow-up monitoring is going to be covered by insurance. Some insurances may require wearing an external 14 or 30 day monitor before approving a loop recorder procedure. In addition, I have noticed more patients where those 30-day monitoring reports from home are not being covered by insurance. So you’ll have to discuss with your doctor if the actual implant procedure as well as the monitoring afterwards will be covered by your insurance. Fortunately for those in which the monitoring reports are not covered by insurance, you can still come in the office and get these recorders checked in person. Fortunately, there are a few options available for the long-term monitoring.

In Conclusion:

Anytime you are thinking about getting an implantable loop recorder, always discuss with your doctor what the long-term plan is. Discuss with your doctor whether you’ll need it for just a few months or possible even for the entire battery life, which is typically about three years.

I find implantable monitors to be a very useful tool for a lot of patients with atrial fibrillation. The device in the current size has been around for over five years now, which allow patients to resume their normal activities with the benefit of continuous cardiac monitoring.

In addition there are now several at home monitors and wearable technology that can be used to monitor atrial fibrillation that do not require a procedure, such as the Kardia Mobile and the Apple Watch Series 4. But as always, please discuss with your doctor which monitor device is the right option for you.