Implantable Loop Recorders: A Breakthrough in Heart Monitoring

Authored By: Dr Amitabh Yaduvanshi

Cardiovascular diseases are a leading cause of death worldwide. According to the World Health Organization (WHO), cardiovascular diseases, which are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions, claim an estimated 17.9 million lives each year. More than 85% of CVD deaths are due to heart attacks and strokes, and one-third of these deaths occur prematurely in people under 70 years of age.

Early detection and treatment of abnormal heart rhythms are crucial for managing heart diseases. One of the most effective ways to detect abnormal rhythms is through long-term heart monitoring, which allows doctors to identify patterns and trends that may reveal a problem. However, traditional methods of long-term heart monitoring, such as Holter monitors and event monitors, are cumbersome and uncomfortable for patients to wear.

To address this challenge, scientists have developed a breakthrough heart monitoring device called an implantable loop recorder or ILR. The ILR is a small heart recording device that is implanted in the body underneath the chest skin, just below the collarbone. The procedure is minimally invasive and typically requires local anaesthesia. The implantation procedure takes less than 15 minutes and can be done on an OPD basis. The patient may resume back to normal activities from the next day itself. 

The ILR works as an electrocardiogram (ECG), continuously picking up electrical signals from the heart, and can help find abnormal heart rhythms that can cause a number of problems such as fainting and palpitations. But why do patients need ILR when options like ECG are already available?

Some heart rhythm problems such as atrial fibrillation, which is an irregular and often very rapid heart rhythm and increases the risk of stroke, heart failure, and other heart-related complications, occur only sporadically. The healthcare provider may not be able to analyse the specific rhythm problem using tools like the ECG. Even using traditional monitoring methods, the patient may have to wait for an episode to occur before a diagnosis can be made.

This is one big differentiator of the ILR. Since the ILR is continuously monitoring the heart's electrical activity, the healthcare provider can analyse the heart rhythms at different stages of time and detect anomalies even if they happen infrequently. The doctor can make a diagnosis according to the heart’s rhythm, and help detect such conditions or refine the treatment of existing conditions. Moreover, ILR works for an extended period of time, typically up to three years.

Using the latest technological tools, the ILR can also be programmed to automatically detect and record specific heart rhythms. For instance, the doctor can set the device to detect and record episodes of atrial fibrillation. The feature is a blessing for patients who have symptoms of atrial fibrillation but are not sure of what they are experiencing.

Another advantage of ILR is that it allows remote monitoring. It is equipped with a small transmitter that sends the heart monitoring data to a separate device worn by the patient. The device transmits the data to a remote monitoring centre, where it can be reviewed by the doctor, who can then decide the future course of treatment depending on the findings. The remote monitoring feature is especially useful for patients who live in remote areas as also those who have mobility issues.

The healthcare provider may recommend implanting a permanent pacemaker or cardiac defibrillator, suggesting further testing, or performing a therapeutic procedure depending on the analysis of the data collected with the help of the ILR and the patient’s symptoms.

The ILR has been found to be very safe, but just like any other implantable device, it is also not 100% risk-free. There is a risk of bleeding or bruising, infection, and allergic reaction, and though it is very rare, it may cause damage to the heart or blood vessels. In case the device malfunctions or stops working for any reason, it may require additional surgery for removing or replacing it. The risks depend on the patient's age, other medical conditions, and other factors, but let me clarify that the risks associated with ILR are very rare and most of the patients report little or no problems with the device.

In the end, I would like to say that ILR is a breakthrough device in heart monitoring. The benefits of long-term monitoring of the heart’s activity and remote monitoring make it an unmatched device of its kind. The risk is there but the benefits of ILR far outweigh the potential risks for patients. If you or anyone you know is experiencing abnormal heart rhythm, talk to the doctor today and check if getting an ILR may be a good option.

(The writer is the Head of the Department of Cardiology at Holy Family Hospital in Okhla, New Delhi)