Making decisions…. Monitoring arrhythmias?

Hi everyone

I was presented with some choices today when speaking to my cardiologist. I had an arrhythmia episode nearly two weeks ago which was different to anything I'd had before and seemed to wipe me out for a few days after. Like a run of powerful ectopic beats one after another without a break.

My cardiologist offered me a loop recorder (this would be my third). But also wanted a conversation about whether this was the best idea. I found my last explant of my loop recorder quite distressing and painful (the local anaesthetic didn't work despite loads of it, the device was stuck and was a nightmare to get out, I felt the stitches being done so they abandoned that and glued the incision the best they could). These things take a lot out of me and these experiences don't make me feel positive. I don't care about scars, but i'm tired of invasive procedures. I like everyone else will have to have multiple pacemakers (hopefully lots as that means a long life). It all takes its toll. 

My last loop recorder didn't pick up anything dangerous in 2 years. My worst unexplained arrhythmias happened in the past year after the loop was removed (typical), but these are infrequent and short lived. I’m 37 now, so may well need arrhythmia monitoring at some point as I get older. Conditions change, age increases these issues for everyone, I know single chamber PMs like mine can increase risk of AF or some type of synchronisation problems and I have significant family history of AF already.

Would you take the loop recorder again now? Or would you wait until something more significant happens? (Or doesn't hopefully).

I have been offered a 6 day holter type monitor as an alternative. I have said yes to that, but can't seem to make a decision about the loop recorder. 

Any suggestions or different perspectives welcome... 

3 Comments

Loop recorder

by AgentX86 - 2022-10-08 00:54:45

I've never had a loop recorder but I've had Holter tests countless times.  The problem with Holters is the shortish test.  A holter looking for an arrhythmia with a low probability might miss it. A week is about as long as they can go and battery changes are needed for even that.

If the arrhythmias affect your quality of life, yes, I think a loop recorder is the way to go. Discuss this with your EP, though.  Ask what he'll do if he find anything. If nothing, why bother?

Reveal Linq implant monitor

by Gemita - 2022-10-08 03:23:59

Claire, I'm impressed your team are offering a third implant monitor, especially since you already have a pacemaker to prevent a falling heart rate, pausing and syncope, which was a clear reason for my Reveal Linq implant monitor in 2016 which lasted 3+ years.  I had no difficulty having mine explanted when the battery died, although my doctors said many patients leave the implant in place for life without harm, having it explanted only before a cremation.

As my implant was instrumental in finding even the briefest episodes of AF (atrial fibrillation) with a rapid ventricular response rate, which shorter term monitoring missed, I was able to start anticoagulation for stroke protection promptly which is often why an implant is recommended Claire.  For this reason alone I believe it would be beneficial to have another loop recorder implanted if you have any risk factors, otherwise you will have to continue to have regular holter monitoring.  Alternatively you could invest in a Kardia Mobile and take/send the evidence to your doctors for analysis and interpretation.  I know many members who regularly do this.

Of course as AgentX86 says, it really depends what your EP/cardiologist is going to do with the findings of your implantable loop recorder?   If he intends to make a decision say about anticoagulation (although you are young and may not have risk factors for an AF related stroke?), or wants to see your total arrhythmia burden to guide treatment with medication and/or an ablation, then that might make an implant worthwhile but there has to be a good reason why you should have a third implant?  Is your doctor concerned about a dangerous arrhythmia and whether you will need to be considered for an ICD implant in the future, for example?  These are all questions that need answering.

Thanks

by _Claire_ - 2022-10-09 16:54:25

Hi agentx86 - yes, the holter monitor didn't find anything with me when I had it a few years ago. I think I had it 24 or 48 hours (can't quite remember now). The loop however, did its job perfectly. It's so hard to pick anything episodic up without a loop recorder, unless it's happening frequently.

You both raise some great questions to think about. I hadn't thought of what would they do about any arrhythmia that was discovered. That's a great way to think about it and a great question for me to ask. 
 

Gemita offered the info about the Kardia Mobile. I've already asked her a thousand questions about that, and think it's probably a great additional option for now and the future. I think for really short arrhythmias it probably won't be possible to catch, unless the device is next to me and ready to go! But I think it's very handy to have at home or with me. 
 

I'll take the 6 day holter monitor too offered by the hospital and keep the loop recorder option open, incase I get more episodes. 
 

As always thank you guys 

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