Loop recorder Implant / explant

What is a loop recorder?

A loop recorder is but highly sophisticated heart rhythm monitoring device. The device detects, analyses, and documents heart rhythm when it goes too slow, too fast or irregularly. It is only a diagnostic tool used to detect problems and to guide management. A loop recorder does not fix heart rhythms.

It is the size of a AAA battery and is placed just under the skin. The device has special electrodes on its surface that allows heart rhythm detection. It lasts generally between 2-3 years.

Do I need a loop recorder?

Loop recorder is usually recommended in people with unexpected loss of consciousness or unexplained stroke.

What are symptoms of bradyarrhythmia? 

With slow heart rhythm, you can experience unexpected dizziness, collapse, loss of consciousness, decreased exercise capacity or breathlessness.

 Are there different types of loop recorders?

Yes, different companies manufacture these devices with their own unique offerings. Common loop recorder brands include Medtronic, St Jude Medical and Biotronik.

What are the risks of having a pacemaker?

Common risks and complications (< 1-5%)

• Pain – Not expected to be severe
• Bleeding
• Infection

What are the costs associated with a loop / explant implant?

If you are having this procedure in a public hospital as a public patient, the cost is covered by Medicare.  If you are having this procedure in a private hospital, there is no additional out of pocket cost for our specialists. The usual hospital excess applies. Some anaesthetists have an out-of-pocket cost that we encourage you to discuss prior to your planned procedure.

How do I prepare for a loop recorder implant / explant procedure?

You will receive a letter with instructions and steps required prior to your procedure including, date of admission (Time of admission may be provided by the hospital directly in some cases), fasting instructions, medications to stop and items to bring with you. You will usually need recent blood test for your kidneys and blood count prior.

In General, do not eat or drink for 6 hours before your procedure. Ask your doctor about taking your usual medications. Blood thinners maybe discontinued for 24hrs. If you take SGLT2 (dapagliflozin / empagliflozin) medicine for heart failure or diabetes, you will need to stop taking them at least 3 days before your surgery. Leave any personal items of value such as jewellery at home.

What happens when you arrive at the hospital?

Once you arrive at the hospital for your procedure, you will usually be directed to the cardiac catheter laboratory / operating theatre admission area where you will be formally admitted as a hospital patient. You will be asked to change into hospital gown and put away all your valuable belongings. You will have some basic tests such as ECG, have your vitals recorded, upper chest shaved and have a cannula inserted into your arm to assist with the procedure.

What happens during the procedure?

Loop recorder insertion / explant is a very common procedure and takes approximately 15-20 minutes. Procedure is usually performed in the catheter laboratory or operating theatre.

Procedure can be performed under sedation or under local anaesthesia only. With sedation, you will be given some medications through the cannula to make you comfortable for the procedure. Given the procedure is expected to be quick, many people choose not to have any sedation prior. If you have the procedure performed under local anaesthesia without sedation, you can leave the hospital sooner and do not need anyone to escort you. We generally recommend sedation for your comfort, especially if you anxious about the procedure.

Once you are comfortable, the upper chest is usually shaved again if needed, cleaned with a special antiseptic wash and once dry, a long sterile drape is placed over the site. The drape comes up to your face. You will have someone to assist you if needed. Local anaesthetic is administered at the incision site which numbs the area. You’ll feel an initial sharp and burning or pricking sensation when the local anaesthetic is injected but it quickly becomes numb in less than a minute. You may feel a pulling / pushing sensation during the operation which is normal.

A 1-2 cm cut is made around mid-left chest. A special tool is used to inject the loop recorder into position which takes about 30 seconds. In some cases, a little absorbable suture is required to prevent the loop from falling out and a water-resistant dressing applied on top of the wound.

Loop explants is like implant procedure but takes a few minutes to locate and remove. The incision tends to be slightly longer (2-3cm).

What happens after the procedure?

At the end of your procedure, a simple dressing is applied over the device site. You are expected to leave after a few hours of monitoring if you have had sedation. Someone will have to escort you.

What happens after discharge?

Wound Care:

1. 1. The dressing on your wound should be left in place for one weeks. You may shower, as it  is waterproof, but you cannot submerge yourself in a bath or pool.
   2. One weeks after the operation, please go to your GP to have the dressing removed. Do not remove or change the dressing before this time.
   3. If the wound becomes red, hot, swollen, more painful or starts to drain fluid, see your local doctor immediately, or call my rooms on 9500-0296.

Other Special Issues:

The device can sometimes move down slightly over time. If it is not too much and the wires are not pulled back, this is of no concern.

Airline Travel:

You will be given a card with the details of your pacemaker on it, please keep this in your wallet.  A permanent card (resembling a credit card) will be sent to you in about two months.  Show this to the security check at the airport, they will search you with a wand rather than walking through the usual metal detector gate.

Follow Up:

You will be sent an appointment to see me for a pacemaker check in my rooms in 2-3 months. Usual follow up thereafter is 12 monthly appointments to keep track of the device function. It is recommended that you continue your usual follow up with other treating specialists and medical practitioners involved in your care as usual. If you do not receive an appointment, please call the rooms.

Do I have to take it easy once I have a loop recorder?

You can participate in your physical activity after one week.

How long do loop recorders last?

They last about 2-3 years

Can I have an MRI scan?

Yes, MRI scans can usually be performed with a functioning loop recorder. If they have reached end of their battery life, some loop recorders must be explanted prior to having an MRI. Check with your doctor about the details.

What is remote monitoring?

We can monitor the function of your recorder while you are at home via remote monitoring. This can be through a little box (remote monitor) that you place near your bed or through your smart phone. All important information is stored within your device and the remote monitor communicates with your device wirelessly overnight at a prespecified time. It will do so every night and transmit information 1-6 monthly to a team of technologists who analyse that information. If there is an urgent issue, information will be transmitted that night and the doctor will usually be informed the next day.

Generally, almost all people will be offered remote monitoring to keep track of your device while you are at home. There is a free service and a paid service (External 3^rd party – Remote Rhythm Management). Please feel free to discuss this with your doctor.

Please contact the rooms if you have any questions or concerns at any time.

In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment.