Advanced Practitioner Placement of Implantable Long-Term Cardiac Monitors
Document Type
Article
Abstract
Background: Indications for long-term cardiac monitoring continue to expand. At St. Luke's University Health Network, which comprises 14 hospitals and 1200 inpatient hospital beds with a large stroke center, the four physicians on the electrophysiology service were unable to meet the demands for implantable loop recorders (ILR) implants. Beginning in 2018, our advanced practitioners were trained to implant and later remove ILRs. This has facilitated more timely care for our patients who require ILRs.
Objective: We aim to describe the practice of ILR implantation by advanced practitioners in our health network, the indications for placement, and the complication rate.
Methods: ILR implant training consisted of performing at least 5 supervised implants with demonstration of competence, followed by formal credentialling to perform the procedure independently. All ILR implantations were performed using the same technique in which the ILR pocket is closed with interrupted 4-0 Ethilon non-absorbable sutures that are removed in the office 2 weeks post-implant. Many of the ILR implants occurred on designated days in which 10 to 20 ILRs were implanted per session. We report in this abstract the data regarding indications for implantation and complications encountered. Results
A total of 512 ILR implants were done by advanced practitioners. Indications for ILR implant: Cryptogenic stroke - 230 Syncope – 79 Atrial fibrillation management - 78 Suspected atrial fibrillation - 53 Palpitations - 33 Atrial fibrillation ablation - 23 Ventricular tachycardia - 9 Other – 7 Out of 512 ILR placements there were two complications, with an overall complication rate of 0.4%. One ILR site did not heal appropriately causing the device to dislodge from the pocket; this was the only unsuccessful ILR. The second complication was external bleeding from the ILR site in a patient on dual antiplatelet therapy which was treated with additional suturing in the emergency department later that evening.
Conclusion: As demand for long-term cardiac monitoring increases, advanced practitioners can play a crucial role in safely performing the procedure with very low complication rates. In our institution this has remarkably improved access to care on both an inpatient and outpatient basis. Cryptogenic stroke accounts for the majority of long-term cardiac monitor placement at our institution.
First Page
S261
DOI
10.1016/j.hrthm.2024.03.849
Publication Date
5-1-2024
Recommended Citation
Field P, Ferraro B, Dixit S, Roma N, Friend R, Breslin M, Traub D. PO-02-174 ADVANCED PRACTITIONER PLACEMENT OF IMPLANTABLE LONG-TERM CARDIAC MONITORS. Heart Rhythm. 2024 May 1;21(5):S261.