Implantable loop recorder

Placement of an implantable Holter is a short procedure performed on an outpatient basis under local anesthesia. It requires neither hospitalization nor general anesthesia.

• A small 1 cm incision is made in the chest area, usually to the left of the sternum;
• The device is inserted under the skin, followed by closure with a stitch or adhesive strip;
• Procedure duration: about 15 to 20 minutes;
• Immediate programming of the device by the rhythmologist.

A remote control is given to the patient to manually signal any symptoms felt, helping to target the analysis of specific events.

The implantable Holter is recommended in situations where heart rhythm abnormalities are infrequent, rare, or unpredictable. It is a reference solution when conventional diagnostic tools (standard ECG, 24- to 72-hour Holter) cannot capture the suspected event.

• After a stroke (CVA) with no identified cause: the device can be used to detect silent paroxysmal atrial fibrillation, a common cause of cryptogenic stroke, often absent during initial examinations.
• In cases of unexplained fainting, loss of consciousness, or syncope: when the standard cardiac work-up (ECG, echocardiography, standard Holter) is normal, prolonged recording can detect a sinus pause, severe bradycardia, or transient arrhythmia.
• When symptoms occur far apart in time: if palpitations, dizziness, or fainting spells occur only a few times a year, a 24- or 48-hour test is insufficient. The implantable Holter ensures permanent electrocardiographic monitoring, even without noticeable symptoms.

This type of monitoring is particularly useful in the context of a complex differential diagnosis, when the goal is to document a rhythm disorder that is invisible at rest or cannot be reproduced on demand.

Same-day discharge is planned right after the procedure, with no hospitalization required. A post-operative care sheet is given to the patient to ensure optimal follow-up from the very first hours. The post-implantation protocol aims to guarantee proper healing, activation of the device, and reliable analysis of the transmitted data.

• Local care at home: the implantation site should be kept clean and dry for about 7 to 10 days. Gentle cleaning with water and mild soap may be recommended after the first 48 hours, unless otherwise advised. The scar should be checked for the absence of redness, unusual pain, or discharge—possible signs of local infection.
• Medical monitoring: remote monitoring is usually activated as soon as the device is implanted. It relies on a telecardiology system, where the data recorded by the Holter is transmitted daily or in real time to a secure platform. The rhythmologist can thus quickly detect any rhythm abnormality, even if silent.
• Use of the patient remote control: the patient is provided with a small device to mark an event as soon as symptoms such as palpitations, dizziness, or loss of consciousness occur. These recordings are especially valuable in establishing a temporal link between symptoms and the heart’s electrical activity.
• Follow-up consultation: the first consultation is usually scheduled 1 to 3 months after implantation. It allows assessment of the local tolerance of the implant, review of the initial data collected, and adjustment of detection settings if needed. An earlier visit is arranged if symptoms or automatic alerts are reported through remote monitoring.
• Long-term follow-up: the implantable Holter remains active for several months to several years depending on the initial indication. Regular data analysis helps confirm or rule out a diagnostic hypothesis (atrial fibrillation, bradycardia, sinus pause, etc.) and determine whether additional treatment (medication, ablation, pacemaker) is needed.

This device is part of a modern, discreet, and high-performance monitoring strategy, allowing patients to resume normal life while benefiting from continuous medical oversight. The Rythmopôle team manages the entire follow-up, in coordination with the primary care physician or referring cardiologist.

The implantable Holter represents a major advancement in monitoring heart rhythm disorders. It offers many advantages over short-term monitoring devices, particularly when symptoms are rare or difficult to reproduce.

Benefits of an implantable Holter:

• Long-term continuous monitoring: the device can record the heart’s electrical activity for several months or even years without interruption. This extended duration greatly increases the chances of capturing transient or rare cardiac abnormalities that often go undetected with conventional 24- or 48-hour tests.
• Miniaturized format and complete discretion: once inserted under the skin, the Holter is completely invisible. Its small size (about that of a USB stick) and subcutaneous placement ensure maximum comfort in daily life, without interference in routine activities.
• Automatic recording of abnormalities: the device is programmed to autonomously detect abnormal electrical events in the heart, such as pauses, extreme slowdowns, or rapid arrhythmias. These recordings are time-stamped and stored in memory for later analysis by the medical team.
• Manual activation possible: in the event of discomfort or noticeable symptoms, the patient can manually trigger a recording using a provided remote control. This allows for precise correlation between sensations felt and the heart’s actual activity at that exact moment.
• Remote monitoring via telecardiology: the device can be connected to a home transmission unit that regularly sends data to the medical center. The rhythmologist can then review heart activity remotely and respond quickly to abnormal findings, without waiting for the next consultation.
• Better symptom/diagnosis correlation: by capturing the exact episodes reported by the patient, or by recording silent abnormalities, the implantable Holter makes it possible to establish a reliable link between clinical symptoms (syncope, palpitations, dizziness) and the underlying rhythm disorders.

In short, this device combines advanced technology, comfort, and diagnostic precision. It is an effective solution for refining a complex cardiac work-up, guiding appropriate treatment, and improving patients’ quality of life by reducing the uncertainty associated with intermittent symptoms.