Prolonged Loop Recorder Retention: Safety, Diagnostic Yield, and the Case for Community-Based Explantation.

BACKGROUND

Implantable loop recorders (ILRs) or insertable cardiac monitors (ICMs) are vital for long-term cardiac monitoring to diagnosed arrhythmias in patients with cryptogenic stroke, syncope, recurrent palpitations, and heart disease. Their increasing use raises demand on limited resources, worsened by the response to Covid-19, which led to deferring elective procedures such as ILR removal. We examined whether longer ILR dwell time was linked to more complications, assessed diagnostic yield, and compared explantation costs between a hospital and simulated community clinics.

METHODS

We retrospectively reviewed all ILR implantations at the London Health Sciences Centre from 2011 to 2025. We recorded patient characteristics, implantation and explantation dates, diagnostic findings, complications, and institutional cost data. We also modelled a simulated community-based explantation cost using local clinic resource estimates.

RESULTS

Among 772 patients, the mean device dwell time was 3.4 years; in the 355 patients (46%) who retained devices beyond the 3.25-year recommended replacement time the mean duration was 5.5 ± 2.2 years. The overall complication rate was 8.0% (n = 62): patient-reported discomfort (3.9%), recording errors (1.8%), unsuitable device position (1.2%), excessive bleeding (0.5%), and infection (0.7%). On a time-to-event basis, the complication rate was highest in the first 180 days (4.13 per 100 device-years) and was not significantly higher beyond the recommended replacement time (incidence-rate ratio 1.36; P = 0.24). Symptom-rhythm correlation was established in 38.4% of patients. Explantation costs for ILR were approximately $490 per case in the hospital setting and $70 in the simulated community clinic, resulting in potential savings of 85.7%.

CONCLUSIONS

Prolonged ILR dwell time didn't increase complication rates. Findings support deferred explantation and community removal to lower costs, but safety and feasibility need prospective studies.