How Does an Implantable Loop Recorder Help Manage Atrial Fibrillation?
What is a 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 monitor or a 30-day monitor from your doctor’s office. However, managing atrial fibrillation is a long-term condition and requires long-term management.
When patients are wearing a 24-hour or a 30-day monitor, what happens when a patient gets symptoms after that monitor period is over? If the patient is no longer wearing that monitor, it can be very difficult for your doctor to know what it is that you're experiencing. Sometimes during a 30-day monitor it is possible that you never have any episodes for your doctor to be able to tell what it is that you are experiencing. Fortunately now there are great options such as implantable loop recorders.
How are Loop Recorders Implanted?
Implantable loop recorders are these small, little devices that actually go underneath your skin. They take typically five 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, and basically the monitor gets pushed underneath your skin, right over where your heart goes. Again, usually it only takes about five minutes to put in, you then get a bandage put on, and then you go home.
These monitors are like the heart monitors that you 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 your atrial fibrillation is doing.
What are the main reasons why somebody should consider having one of these monitors put in?
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 these severe sudden symptoms that are infrequent this recorder is something that could help your doctor, in order 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 without any warning signs. The difficult part about management of passing out is that unless you actually catch an episode when it's happening, it's hard for your doctor to figure out if that passing out or dizziness is related to either your AFib or slow heart rate, and how to better manage 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. People when they have a stroke and it's not clear why the stroke happened, a common reason could be undiagnosed atrial fibrillation. These monitors in place can help detect previously undetected atrial fibrillation and help put patients on the correct treatment plans to prevent future strokes.
Lastly, one of the other treatment options for these devices is for the management of someone's atrial fibrillation. There're 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 that just can't tell, or they have very subtle symptoms when they're in atrial fibrillation. This device can help your doctor’s office better gauge how the 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 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.
In addition these implantable monitors send routine reports over to your doctors office. Usually they send a monthly report, which is usually sent through either a smartphone or a little home monitor that you have at home. These implantable monitors do have an antenna on it that then transmits the data over to either your smartphone or to the home monitor that you get, which then relays the information to your doctors office.
There are a couple different brands of implantable monitors available right now. The Medtronic Linq as well as the Abbott Confirm Rx, which are both great implantable, loop recorders and I use both of them on my patients. Anytime you are thinking about getting an implantable loop recorder, always discuss with your doctor what the overall 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.
These implantable monitors are typically covered by insurance. The implantation of it, like I said, is usually only five minutes. But always discuss with your doctor, including the follow-up monitoring, if it's going to be covered by insurance. 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. So there are a few options available for the long-term monitoring.
I find implantable monitors to be a very useful tool for a lot of patients with atrial fibrillation. The device in the current sizes has been around for probably close to five years now. Now in this current smaller size, much more patients are using it, the device used to be much larger, about the size of a finger. In addition there are now several at home monitors and wearable technology that can be used to monitor atrial fibrillation, 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.
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