ECG signal

Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Cardiac Investigations - Implantable Loop Recorder (ILR, Reveal device)

If a patient has very troublesome but infrequent symptoms, for example feeling faint, severe palpitations or loss of consciousness, it is highly likely that short-term monitoring will fail to pick up the underlying abnormality. In these circumstances it may be appropriate to use an implantable loop recorder (ILR) such as the Reveal™ device, which has been available for a number of years. The ILR is a compact but highly sophisticated device, smaller than a pack of chewing gum, which is implanted under the skin on the front of the chest; this is performed as a day case procedure, taking 30 to 40 minutes, and requiring only a local anaesthetic.

The ILR continuously monitors the heart beat and ECG for the lifetime of the battery, approximately three years in the latest models. Sudden changes in heart rate are automatically recorded by the device and can be subsequently downloaded using a programmer, which looks like a laptop computer. The patient, or a family member or friend, can also activate the ILR to store information on the heart beat at the time of symptoms or upon recovery, whichever is most practical. The ILR is activated using a small hand-held device which is placed on the skin overlying the ILR; pressing the button on the activator stores the ECG for a set period of time before, during and immediately after the activation. The activator should be carried by the patient at all times.  By looking at automatically stored and patient stored ECGs it is possible to determine whether or not a patient’s symptoms are due to significant changes in the heart rate and rhythm. Once a diagnosis has been made, or if it becomes clear that there is not an underlying heart abnormality, the ILR is removed under local anaesthetic. If it has been shown that the symptoms are due to inappropriate slowing of the heart a permanent pacemaker can be inserted at the same time.

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Cardiac Investigations - Implantable Loop Recorder (ILR, Reveal device)Cardiac Investigations - Implantable Loop Recorder (ILR, Reveal device)