Royal Sussex County Hospital. Princes Royal Hospital. Hove Polyclinic. Sussex Universities

Implantable Loop Recorders

What is a loop recorder?
A loop recorder is a revolutionary medical implantable device that continuously monitors the heart rhythm for up to 14 months. The Implantable Loop Recorder (ILR) can determine if fainting is related to heart rhythm problems in 94% of cases. Smaller than a pack of gum, the ILR is inserted just beneath the skin in the upper chest in a brief out-patient procedure that typically takes 15 to 20 minutes.
The ILR captures an E.C.G. during the actual fainting (dizziness) episode, which allows the doctor to confirm or rule out an abnormal heart rhythm more definitively than other tests. There is the benefit as well in knowing if the cause of fainting is not heart-related because it enables the doctor to focus on other possible causes. Most importantly, diagnosing the cause of fainting (or dizziness) can lead to effective treatment more quickly.

How is the device inserted?
It is inserted beneath the skin in the upper chest area.  This area will have been numbed with local anaesthetic first.

When can I eat and drink?
You must not have anything to eat after 3am on the day of your procedure and you may only drink clear fluids (no milk) until 7am.  After this time you may not have anything until after the procedure.

What tablets can I take before the procedure?
Warfarin needs to be stopped for 5 days prior to your admission date.  Aspirin and clopidogrel should not be taken on the morning of admission.  Insulin dose should be halved on the morning of your procedure.

What should I bring into hospital with me?
You will need to bring all your current medications with you and details of your GP and next of kin.  Please bring a dressing gown and slippers with you, you may also wish to bring a book/magazine.  Please do not bring any large amounts of money or jewellery with you, the hospital is unable to accept any liability for lost or stolen items.

What happens after the procedure?
Afterwards a small dressing will be applied and you will be advised when to remove this. You will also be informed if non-dissolvable stitches have been used and when these will need to be removed. A Cardiac Physiologist will explain how and when to use the reveal device. This is a day case procedure and you can usually go home once you have seen the Cardiac Physiologist.

How does it work?
Once the ILR is implanted in your upper chest area, it is programmed to continuously monitor your heart’s activity in the form of an electrocardiogram (ECG). When an episode occurs, a patient (or family member) immediately places a small hand-held activator over thel monitor and presses a button. This records the heart’s signal before, during, and after the episode. The ILR can also record abnormal rhythms automatically if programmed to do so by your doctor. a patients' events (usually up to three) have been successfully captured (using an activator over the ILR, a green light on the hand held device will confirm that an E.C.G. is being stored) a visit to the E.C.G. department is necessary to retrieve the stored E.C.G. from the ILR memory and analysed.

How to use your activator
1. Placeyour Activator over your implanted ILR, either on your skin or over your clothing.
2. Press the Activator’s white button once.
3. Immediately remove the Activator and observe the flashing light:
 A flashing green light above the check-mark symbol means the Activator successfully signalled the ILR. You do not need to press the white button again.
 A flashing yellow light above the stop symbol means the ILR did not receive the signal from the Activator, and an ECG is not being stored.
4. Reposition your Activator over your implanted ILR, and press the white button again if you see a flashing yellow light. (Repeat until you see a flashing green light.)
5. After you have used your Activator to store an ECG, contact your doctor or nurse and follow their instructions.

Important Things to Remember About Your Activator
Always keep your Activator with you.
Tell the important people in your life about your ILR and how to use the Activator.
Protect the white activation button, and make sure it is not pressed unless you need to store an ECG.
Guard against accidental use of the Activator by keeping it in its carrying case. Carry it around your neck or clipped to your clothing rather than in a purse or briefcase.
Do not drop or handle your Activator in any way that might damage it. If you drop your Activator, test it by pressing the white button while holding it at arm’s length from your implanted ILR. If the yellow light flashes, your Activator is functioning.
Do not immerse your Activator in liquid. It is water-resistant, but not waterproof.
Do not expose your Activator to temperatures below 48 degrees F. (9 C) for extended periods of time. In cold climates, carry your Activator in an inside pocket to protect it from the cold. Place your Activator over your implanted ILR, either on your skin or over your clothing.

Important Daily living with your Reveal loop recorder
Always keep your Activator with you. Some equipment in your daily surroundings uses electricity and magnets that have electromagnetic fields around them. These fields are usually weak and will not affect your heart monitor. However, strong electromagnetic fields can interfere. Below are tips for avoiding interference with a few common items.

Airport Screening Devices
It is unlikely that airport screening devices will interfere with your ILR, but they may detect the metal components and set off the alarm. It may be necessary to present your device identification card to obtain clearance. You may wish to be hand searched instead of going through the security archways.

Cellular Phones
There may be temporary interaction between cellular phones and the Reveal Plus ILR. This potential can be minimized by following these guidelines:
Maintain a distance of six inches (15 cm) between a hand-held personal cellular phone and the ILR implant site.
Hold the phone to the ear on the opposite side of the implant site.
Do not carry the phone in a pocket on the same side as the implant site, because some phones emit signals when they are turned on but not in use. Storing the phone in a location opposite the side of the implant is recommnended.
For phones transmitting above 3 watts (e.g., many portable and mobile cellular phones), a minimum separation of 12 inches (30cm) between the antenna and the heart monitor is advised.
Moving the cellular phone away from the ILR will return the ILR to its previous state of operation.

Home or Job Environment
The ILR should not be affected by the normal operation of electrical equipment such as household appliances, electrical machine shop tools, microwave ovens, spark-ignited internal combustion engines, radio frequency transmitting systems, or microwave frequency transmitting systems.

Medical Procedures
Always tell medical personnel that you have a Reveal Plus ILR. With proper precautions, most medical procedures are unlikely to interfere with the function of your monitor.

Follow-up visits
After the Reveal® Plus Insertable Loop Recroder (ILR) is implanted, the technician will schedule periodic office or clinic visits. If you have a fainting episode after your Reveal Plus ILR is implanted, you should promptly call the cardiac department to schedule an appointment to check your heart monitor.
During an office visit, a programmer is used. A programmer is a specialized computer that receives information stored in your monitor. It can also be used to change some of the ILR’s settings-- without surgery. The technician will use the downloaded information to determine if your symptoms are related to your heart rhythm. After analyzing the information, your doctor can let you know which treatment is best for you. A clinic visit usually lasts about 30 minutes or less.

Removing the device
Once your heart’s activity has been recorded during your symptoms and the doctor is satisfied that any heart-related causes are identified or ruled out, the device will be removed.
The removal of the ILR is similar to when you had it implanted and can be carried out in a day clinic.

Courtesy of Arrhtyhmia Alliance. Registered Charity No. 1107496 ©2010