43 Feasibility of implantable loop recorder implantation and removal by a nurse

Introduction The use of an implantable loop recorder (ILR) is recommended in the investigation of patients with recurrent unexplained syncope. Historically, at our centre, all ILR insertion and removal procedures were performed by a physician. The aim of this study was to determine if these procedures could be performed safely and effectively by a nurse. Methods Following a period of training, ILR insertion and removal procedures were performed by one band 6 nurse. Procedures were performed in the cardiac catheterisation laboratory along with a clinical physiologist. A short-term successful procedure was defined as one resulting in a sensed R wave > 0.4 mV (if applicable) without a complication (any problem requiring the involvement of a physician or any problem requiring a further surgical procedure) during the initial hospital attendance. A medium-term successful procedure was defined as one resulting in a sensed R wave > 0.4 mV (if applicable) without a complication (treatment with antibiotics for a wound infection or any problem requiring a further surgical procedure) 6 weeks following the procedure. Results Between 17/08/18 and 26/02/19, 60 ILR procedures were performed by a nurse, 44 (73%) had an ILR inserted (23 Reveal XT (Medtronic, Dublin, Ireland); 4 Reveal LINQ (Medtronic, Dublin, Ireland) and 17 Confirm (Abbott Laboratories, Lake Bluff, Illinois, U.S.)). 16 (27%) had an ILR removed (4 Reveal XT; 5 Reveal LINQ and 7 Confirm). Mean patient age was 56 years and 40% were female. The most common indication for ILR insertion was unexplained syncope (84%). All ILR procedures were successful in the short-term and medium-term. One patient developed bacteraemia requiring treatment with intravenous antibiotics 6 weeks after ILR insertion. This was not felt to be related to the procedure and there was no evidence of wound infection. A potentially clinically relevant arrhythmia was detected in 4 patients (6%) within 6 weeks of ILR insertion. Conclusions This study demonstrates that ILR insertion and removal procedures performed by a nurse are safe and effective in the short- and medium-term. ILR procedures formed by a nurse are likely to be less expensive than those performed by a physician.