Cardiology - Implantable Loop Recorder (ILR)

What is an ILR?

An ILR also known as a LINQ is an implantable medical device that continually monitors your heart rate and rhythm. It represents a breakthrough in the diagnosis of unexplained fainting or blackouts and irregular heart rhythms. The ILR can determine if fainting is related to a heart rhythm problem which occurs in up to 80% of patients. The device is inserted just under the skin, during a short outpatient procedure. It is important to remember that your ILR is a diagnostic tool and will not provide any therapy during symptoms.

Why have an Implantable Loop Recorder?

An ILR is a long term monitoring device that is used for patients with infrequent symptomatic episodes. It is also used when short term ambulatory monitoring or other tests haven’t been able to explain the cause of presenting symptoms or a diagnosis hasn’t been met. The benefit of capturing your heart rate and rhythm (known as an electrocardiogram or ECG) before, during and after enables your doctor to confirm or rule out if an abnormal heart rhythm is the cause, leading to a correct diagnosis and treatment more quickly.

How does it Work?

An ILR continually records and deletes the ECG seen on a loop. For infrequent symptoms or irregular heart rhythms that haven’t yet been explained it allows for automatic and patient activation of symptoms which prompts the ILR to record the ECG. Any recording the ILR makes either via patient activation or automatic shows before, during and after the event and can be reviewed by the doctor. This allows the doctor to rule out if an abnormal heart rhythm has occurred more definitively than other tests.

How long will I need it?

The ILR can remain in place for up to 3 years although this depends on the frequency of your symptoms. However, once your doctor has sufficient information the device can be removed. This will involve another very simple operation and appropriate treatment given.

What does the implant involve?

The insertion of the ILR will be done as a day case. No sedation is required. The recorder is a small device and is inserted beneath the skin in the left upper chest area over the pectoral muscle after local anaesthetic has been used to numb this area of your skin.

The procedure takes approximately 10 to 15 minutes. Once the device has been positioned under the skin, the wound will be closed with sealant glue.

The procedure involves a small risk of bleeding, bruising, a possible reaction to the local anaesthetic or infection to the device site. Your doctor/implanter or cardiac physiologist will discuss this with you and will ask you to sign a form to obtain your consent for the procedure.

My Carelink Heart App

You will be asked to download this app on your mobile phone or tablet, and you will need to have access to your passwords and emails.

To check to see if your phone/tablet is compatible with having this app you can scan the below QR code by opening the camera.

How do I record a symptom on the app?

Using the app select ‘record new symptom’ and follow the on – screen prompts to complete the transmission. For this reason, we advise keeping your smartphone or tablet nearby for quick access to the app. Please leave the app on in the background and Bluetooth turned on so it can connect to your device.

OR

My Carelink Relay Monitor

This is what the monitor looks like.

As soon as you receive this monitor it is important that it is plugged in and placed at your bedside. This ensures the Hospital can start receiving your information from your ILR. Once the setup is complete you must leave your home monitor plugged in at all times.

How do I record a symptom with the Relay monitor?

You will have been given a patient activator – picture below.

You will need to always carry it with you so you can use it to mark symptoms such as dizziness, fainting or palpitations. Data is marked in your Reveal LINQ ICM and sent to your doctor during your next automatic transmission.

To use the Patient Assistant:

• When you experience a symptom, press and release the button. The searching light will start to flash blue
• Quickly hold the Patient Assistant flat against your chest, directly over your Reveal LINQ ICM
• When a symptom is successfully marked, the success tone will sound, and the success light will illuminate green. If the success signals do not occur within 15 seconds, repeat steps 1-2

At times, it may be necessary to attend the Cardiac Investigations Department. We will inform you of this either by telephone call or letter to your home address.

What happens before I go home?

Before discharge you will be shown and explained how to use the patient external hand held activator to record a symptomatic event and also how to use the wireless CARELINK monitor to transmit the information to the hospital from the comfort of your home.

You will be given an easy to follow leaflet with information, contact names and numbers. When all the explanations are completed and you feel fit, you will be discharged from the department.

You will be given an ID card which includes your LINQ details and should be carried with you at all times. If you are admitted to another hospital this card should be shown to the healthcare professional looking after you. Please also note that the ILR LINQ is MRI safe and should not prevent you having an MRI scan.

The Cardiac Physiologist will be able answer any questions you may have on the day following the implant of the ILR.

If you have any further queries you can contact Cardiorespiratory department, Monday – Friday from 8am – 5pm on 0161 778 2028

Any medication queries before your procedure contact Pre Op Nurses Monday – Friday from 8am – 5pm on 0161 778 2528.

Device follow-up schedule

Four to six weeks post implant you will have an appointment to come to the Cardiac Investigations Department for a site check and initial appointment to check your ILR by the Cardiac Physiologists.

Following this initial face to face appointment of your ILR, subsequent checks will primarily be done from the comfort of your own home using the wireless home monitor.

These transmissions will be either:

1. Automatic transmission (usually sent at night while you sleep) and the transmission will send if any information is collected in the automatic device memory. These transmissions are routine for all patients, however we therefore recommend that your home monitor is plugged in at all times.
2. Manual transmissions, to send information once you have used your patient activator (maximum 3 times).

Our clinic will routinely schedule your Home monitor transmission to occur approximately every 3 months (as well as sending downloads when you have symptoms) and you will be seen face to face in our clinic every 6 -12 months.