Implantable Loop Recorder (ILR) devices play a crucial role in long-term rhythm surveillance for patients with unexplained syncope, suspected intermittent arrhythmias, cryptogenic stroke, and infrequent palpitations that evade detection through short-term monitoring. This session provides an in-depth exploration of ILR indications, implantation techniques, signal interpretation, remote monitoring workflows, and clinical decision-making. Many clinicians attend an cardiology conference to strengthen their understanding of arrhythmia surveillance, case selection, and interpretation frameworks, which aligns closely with the practical depth offered in this session. The description also integrates practical insights on how advanced ILR monitoring strategies enhance diagnostic accuracy and streamline management across outpatient and remote settings.

The session begins by reviewing the role of ILRs in modern arrhythmia diagnostics. Unlike Holter monitors or patch ECG systems that record continuously over short intervals, ILRs provide multi-year monitoring with automatic arrhythmia detection algorithms. Participants will understand how these devices capture bradyarrhythmias, pauses, atrial fibrillation, ventricular tachyarrhythmias, and episodes linked to patient-activated symptom triggers. The discussion emphasizes the clinical situations where ILRs significantly alter diagnostic pathways, such as recurrent syncope with inconclusive initial testing or unexplained stroke where occult AF is suspected.

The implantation technique is covered in detail, including local anesthesia use, incision placement, device positioning, and troubleshooting during insertion. Participants will learn how modern ILRs enable “no-suture” or “single-stitch” closure and how proper device angulation improves R-wave sensing. Signal quality, noise filtering, under-sensing, and over-sensing challenges are explained through practical examples.

A major focus is placed on remote monitoring integration. Attendees will explore how daily or weekly transmissions support early identification of clinically relevant arrhythmias, facilitate medication adjustments, and assist in decisions regarding anticoagulation, ablation, pacemaker implantation, or further testing. Best practices for triaging alert burden, coordinating device clinic responsibilities, and communicating findings with referring physicians are covered step by step.

The session also addresses common pitfalls in ILR interpretation. Examples include misclassification of sinus tachycardia, myopotential artifact mimicking arrhythmia, T-wave oversensing, and false AF alerts. Clinicians will learn structured review methodologies to distinguish true arrhythmic events from noise, ensuring more accurate clinical decisions.

Special use cases are highlighted, such as ILR use in pediatric patients, athletes, individuals with neurocardiogenic syncope, post-stroke patients, and those with inherited arrhythmia syndromes. Guidance is provided on ILR explantation techniques, device longevity considerations, and timing of removal once diagnostic yield is achieved.

Future trends include miniaturized ILRs, enhanced AI-driven detection, multi-sensor integration, and automated cloud-based arrhythmia diagnostics. By the end of the session, attendees will understand how ILRs transform prolonged rhythm evaluation and how a structured approach—similar to best practices presented in high-level electrophysiology programs—can elevate clinical care.