This case involves a 62-year-old man who underwent placement of an implantable loop recorder (ILR). The patient, with a history of cardiovascular disease, was referred to cardiology for cardiac clearance prior to hemorrhoidectomy surgery. An echocardiogram revealed moderate mitral regurgitation and the patient said he was suffering from shortness of breath. The doctor recommended an implantable loop recorder. He told the patient the device would be small and would not impede his daily activities. The patient underwent the procedure where the incision was made in the left upper chest. When the dressings were removed following the procedure, the patient was noticeably in pain and the device was protruding outwards. Nevertheless, he was discharged. He visited the hospital multiple times with complaints of chest pain at the site of implantation and so the device was removed. However, he continued to visit the hospital with complaints of pain at the site of implantation, and was eventually placed on pain medications. The pain persisted and he required multiple nerve block sessions.
Question(s) For Expert Witness
- 1. Do you routinely place Implantable Loop Recorders?
- 2. Have you ever had a patient present the complications described in this case?
- 3. When is the use of an ILR medically justified?
- 4. Have you ever published or lectured on the matter?
Expert Witness Response E-061724
I am the Director of Cardiac Electrophysiology and Electrophysiology laboratories at a state university, as well as a Professor of Medicine. I have 14 years experience implanting cardiac devices, including loop recorders. An ILR is medically justified whenever symptoms occur sufficiently. It is rare that a month long monitor will not capture an event.