Patient education: Insertable cardiac monitor placement (The Basics)

What is insertable cardiac monitor placement? — This is a procedure to put a device called an "insertable cardiac monitor," or "ICM," in the body. An ICM measures and records the heart's electrical activity. It might also be called an "implantable cardiac monitor" or "implantable loop recorder."

Each person has a built-in electrical system in the heart (figure 1). This is what controls the heartbeat. When the electrical system is not working properly, it causes an abnormal heart rhythm. Abnormal heart rhythms are also called "arrhythmias." An ICM can tell if a person has an arrhythmia.

You might need an ICM if you have:

●Symptoms such as fainting that are infrequent (happen less than monthly)

●Had a stroke with no clear cause

●Had treatment for atrial fibrillation, or "A-fib," and your doctor wants to see if the A-fib came back

An ICM can record electrical activity for up to a few years.

How do I prepare for ICM placement? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as blood tests.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during ICM placement? — When it is time for the procedure:

●You will get medicines called "local anesthesia." This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a small cut (incision) in your upper left chest area.

●They will insert the ICM through the incision. To do this, they will use a special tool to make a pocket under the skin (figure 2).

●They will close your incision and cover it with clean bandages.

What happens after ICM placement?

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

What are the risks of ICM placement? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

What else should I know?

●Once the ICM is in, you cannot see it. It will be under your skin.

●You will be given a "transmission monitor" when you go home. This collects data from the ICM device and sends it to your doctor. Most of the time, the transmission monitor should be close to your bed. Then, it can collect and send the data at night while you sleep. Your doctor or nurse will give you more information about setting up and using your transmission monitor.

●If you are going to have an MRI (an imaging test), tell the staff that you have an ICM.

●The battery in your ICM will last for 2 to 4 years. To have your ICM removed, you will need another procedure.

More on this topic

Patient education: Insertable cardiac monitor placement – Discharge instructions (The Basics)
Patient education: Ambulatory heart monitoring (The Basics)