Loop Recorder Insertion

Anesthesia Implications

Position: Supine, one arm extended, one arm tucked
Time: 5-30 min (very short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Approach – Bolus 20-60mg propofol. The surgeon will localize the area. The surgery is not incredibly stimulating, but propofol boluses may be given as needed.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

An implantable loop recorder (ILR) is a device that is used to continuously monitor a patient’s heart rhythm. It is used for patients who experience infrequent or transient cardiac symptoms, like palpitations or syncopal episodes. This device is inserted if other tests have failed to find any causes for fainting, palpitations, etc.

After localizing, a small incision  (1-2 inches) is made in the subcutaneous tissue of the chest wall. A loop recorder is then slid under the skin and secured into the pocket. The surgeon then inserts the electrode leads into the heart through the subclavian vein. The leads are then positioned in specific locations within the heart depending on the patient’s condition.

The surface is then closed with sutures.

A loop recorder is the size of a pacemaker and contains two sensing electrodes. It continuously records a single-lead electrocardiogram. Using a magnet, the patient activates the device during a syncopal or presyncopal episode, which will store the preceding 6-40 min segment (the duration depends on the settings). Initially, the loop recorder stores 1 or 2 min of electrocardiography after activation and then 1-3 events, depending on the storage mode settings. The device is implanted in the left pectoral region in the subcutaneous fat and has a battery life of 2 years.

The loop recorder helps to diagnose dysrhythmias requiring a pacemaker or ICD.

The data is then downloaded by a healthcare professional using a programming device.