‘Insertable loop recorder is a mini doctor with the patient’

Dr Balbir Singh, senior interventional cardiologist, Escorts Heart Institute and Research Centre, has for the first time ever in north India implanted an insertable loop recorder (ILR) in an 11-year-old girl. In conversation with Express Healthcare Management, Dr Chugh gives a comprehensive view of syncope and the loop recorder, which is gradually becoming the preferred mode for the diagnosis of syncope all over the world.

How serious is syncope?

Syncope, the medical term for fainting, is the sudden loss of consciousness due to insufficient supply of blood and oxygen to the brain. Many of these patients live in fear of passing out at any time. They may be unable to perform their jobs or drive a car, and many suffer from anxiety or depression related to their syncope. It is estimated that one-third of all patients who suffer from syncope will be seen multiple times by their physicians each year. The diagnosis demand recording of the ECG only at the time of episode, as the ECG prior to and after the episodes will come perfectly normal.

How will ILR help in this?

The ILR has made it possible to record ECG at the time of syncope. It’s a small instrument, smaller than a pacemaker, that is placed inside the chest to record the ECG at the time of blackout episode. It continuously keeps checking the rhythm of the heart and rate. ILR can be activated by the patient himself or somebody with the patient just when the person starts to faint. It is a very simple device because when a doctor has to make a reading of the episode then it is attached to the computer and on computer screen we get the complete ECGs.

How old this technology? What is the cost of the device?

This technology is about four-five years old. In India, it has been here only for a year now. I have done the first case in north India. Earlier, implantation has been done in a hospital in Hyderabad. This device, made of stainless steel, basically is an ECG recorder with electrodes on the surface, which record ECG. Its cost is around Rs 35,000.

When should it be implanted?

Suppose a person gets an episode of unconsciousness once in six months. It is useful for the patients who have episodes of unconsciousness and doctors are unable to find the cause (unexplained syncope). If we investigate 100 patients, in 15-20 we have not been able to find the cause. So it acts like a mini doctor with the patient 24X7 which will pick up the episode.

Tell us about the girl on whom you implanted ILR for the first time?

This was an 11-year-old girl who was facing frequent episodes of “Black Out”. Several investigations were done, which were all negative, including EPS testing of the brain and heart everything was fine. Then we decided to place this device under the skin and recorded some of her episodes when she fainted.