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

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.