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Case Reports
. 2021 Feb 18;5(2):ytab043.
doi: 10.1093/ehjcr/ytab043. eCollection 2021 Feb.

Migration of a new generation implantable loop recorder: a case report

Michael Rahkovich  1 , Avishag Laish-Farkash  1
Affiliations
Case Reports

Migration of a new generation implantable loop recorder: a case report

Michael Rahkovich et al. Eur Heart J Case Rep. .

Abstract

Background: Implantable loop recorders (ILR) are widely used in patients with syncope, palpitations, or cryptogenic stroke. Implantable loop recorder implantation is considered a minimally invasive, low-risk procedure, however, rare complications can occur, including device migration.

Case summary: A 65-year-old woman underwent implantation of the new generation Biotronik ILR-BioMonitor 3-at a typical, standard location as part of recurrent syncope workup. The procedure was unremarkable, without acute complications. The remote communication with the device was lost 1 week later. Chest X-ray and chest computed tomography confirmed device migration into the left postero-inferior part of the pleural cavity. We were able to establish direct device communication from the patients' dorsum (back). The device was retrieved with forceps during thoracoscopy without further complications.

Discussion: There are few published cases of ILR migration into the pleural cavity. To our knowledge, this is the first published case of subpleural penetration of the new generation of Biotronik ILR (BioMonitor 3) which is small in size and has a sharp antenna. We assume that the ILR migrated about a week post-implantation. We suggest that the subcutaneous implantation be done with a minimal penetration angle and parallel to the sternum with close follow-up after the procedure.

Keywords: BioMonitor 3; Biotronik; Case report; ILR; Implantable loop recorder; Migration; Penetration.

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Figures

Figure 1
Figure 1
Interrogation of the implantable loop recorder immediately after the implantation showing R-wave amplitude of 1.98 mV.
Figure 2
Figure 2
The device interrogation from the patient’s left back.
Figure 3
Figure 3
Chest X-ray 1-week post-implantation. (A) Postero-anterior view. (B) Lateral view.
Figure 4
Figure 4
Chest computed tomography 1-week post-implantation. (A) Cross sectional image. (B) Frontal image. (C) Sagittal image.
Figure 5
Figure 5
Video-assisted thoracoscopy. Biomonitor 3 device fixation with the forceps.
None
See this image and copyright information in PMC

References

    1. Preminger MW, Musat DL, Sichrovsky T, Bhatt AG, Mittal S . Migration of an implantable loop recorder into the pleural space. Heart Rhythm Case Rep 2017;3:539–541. - PMC - PubMed
    1. Brignole M, Donateo P, Oddone D . Migration of an injectable loop recorder in the dorsal pleural cavity. Europace 2018;20:24–24. - PubMed
    1. Hasnie A, Hasnie and Ragheb Assaly A . The case of the Migrating Loop recorder. JACC: Case Reports 2019;1:156-60. - PMC - PubMed

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