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Ambulatory electrocardiogram (ECG) monitoring is an invaluable tool to assist in diagnosing certain cardiac conditions. There are a variety of ambulatory ECG monitors, including Holter monitors, event monitors, and implantable loop recorders. Holter monitors are used to record 24 to 48 hours of activity. Event monitors are used to record 2 to 4 hours of activity. Implantable loop recorders can record activity for up to 3 years. The choice among these technologies is usually based on the anticipated duration of monitoring required to capture a spontaneous event. This activity describes the indications, contraindications and clinical significance of the implantable loop recorder. In addition, this activity highlights the role of the interprofessional team in the management of patients with arrhythmias. Objectives: Describe the indications for an implantable loop recorder. Describe the technique involved in implanting a loop recorder. Summarize the clinical benefits of implantable loop recordings. Explain interprofessional team strategies for optimizing care coordination and communication to advance arrhythmia monitoring via implantable loop recordings to improve patient outcomes. Access free multiple choice questions on this topic.

Ambulatory electrocardiogram (ECG) monitoring is an invaluable tool to assess and establish a diagnosis of a patient’s symptoms. There are a variety of possible ambulatory ECG monitors to choose from. Holter monitors are used to record 24 to 48 hours of activity. Event monitors can record 2 to 4 hours of activity. Implantable loop recorders can record for up to 3 years. The choice among these technologies is usually based on the suspected monitoring duration that will be required to capture a spontaneous event. Thus, if symptoms occur daily, a Holter monitor may be adequate. If symptoms occur weekly or monthly, an event monitor may be best. If symptoms occur less than monthly or even a few times per year, then an implantable loop recorder is likely the best option. Typical event recorders may not be useful at all if the patient collapses and cannot activate the device. Because of such, a device that can activate on its own and/or has memory to retain information for later download is preferred. This article will cover implantable loop recorders.[1][2][3] The implantable loop recorder (ILR) is a subcutaneous monitoring device used to monitor electrical activity of the heart over an extended period, compared to the fixed picture of electrical activity that is seen with ECGs.[4]

The most common complication is a pain at the implant site. Risks of the procedure include a local pocket infection that may require removal of the implanted device or a local skin reaction to the device.  Poor R-wave sensing is a rare complication that may require moving the device to another location.

Healthcare workers including the nurse practitioner who deal with patients with syncope and arrhythmias should be familiar with the implantable loop recorder. Unlike the traditional holter monitor, the implantable loop recorder is far more efficient and reliable at identifying abnormal rhythms. However, they should be considered only after a thorough history and physical examination are performed. Family history and medication use should also be discussed with the patient. Initial imaging should include ECG and echocardiogram which may reveal structural heart disease. Other testing such as a stress test or a tilt table test, may be beneficial if indicated. If the patient continues to have symptoms and all workup is unrevealing, then electrophysiology testing and an implantable loop recorder is the best approach in select patients.