An Anatomic-Based Approach for the Placement of Implantable Loop Recorders

Introduction: Placement of the Reveal implantable loop recorder (ILR; Medtronic Inc., Minneapolis, MN, USA) has previously involved preoperative cutaneous mapping to determine the optimal location. We describe an anatomic‐based approach to ILR placement that does not require cutaneous mapping. Method: A total of 63 patients (40 women, 23 men, mean age 38 ± 15 years) were included in the study. Each underwent implantation of a Reveal ILR in the left upper chest area midway between the supraclavicular notch and the left breast area. Thirty‐two patients received a Medtronic Reveal DX ILR and 31 received Reveal XT device. Results: In all 62 patients, adequate electrocardiographic tracings were obtained at implant without the need for preoperative cutaneous mapping, and all were followed for a period of 10 ± 4 months afterwards. The mean P wave amplitude was 0.12 ± 0.20 mV at implant and at follow‐up (6–14 months postimplant); the amplitude was 0.11 ± 0.19 mV. The peak‐to‐peak QRS amplitude was 0.48 ± 0.15 mV at implant and 0.44 ± 0.16 mV at a follow‐up of 6–14 months. The P waves were not detected in two patients at follow‐up. In one patient, decreased amplitude of QRS complex resulted in the autoactivation of the device and in one other patient noise was inappropriately oversensed and recorded. Conclusion: A simple anatomic approach can be used for reveal ILR placement. (PACE 2010; 33:1149–1152)