Do I really need a loop recorder?

He is entirely consistent in logic and in his learning and experience. Honestly!

You have a history of periodic, if short-lived, arrhythmia. It comes and goes without any control on your part. It may even have happened last night while you slept. Any time you're in arrhythmia, you have an increased risk of a stroke. If it's atrial fibrillation, your risk of a stroke is about five times what it would be if you were perfectly healthy....and young. I don't know if you understand why the risk is so high, but it lies in the shape and placement of what is called the left atrial appendage (LAA). It's a shallow cave or grotto high on the extreme left side of the left atrium where blood flow is rather poor at the best of times. When fibrillating, it's much poorer, so poor that slow blood can become a bit stale and want to clot. If the clot(s) become dislodge, and travel to the heart itself, or to the brain, it can cause serious problems, like stroke in the brain. Or an infarct in the heart. Or thromboembolic problems in the lungs. You don't want the clots at all, and the anticoagulant you are taking helps with that. The Flecainide controls your heart rhythm, and that may be necessary or not. If you can convince your cardiologist to go off it for a trail, you may find that you really don't need it. Or, that you do because you begin to get the odd run of AF again.

So why does he say if you go off the meds that you should have a loop recorder? Because of the nature of paroxysmal AF. You may not be sufficiently symptomatic to actually know when it happens, especially during sleep or other activities where your mind is 'busy.'

And, why does he say there's no point to having an implanted recorder if I'm' going to stay on the meds? That's his point....every procedure carries risk, and if you don't want the recorder, and would rather stay on meds because you like what they do for you, then skip the recorder! Stay on the meds because you're being well-treated by them. IOW, choose one or the other. If the recorder is implanted, and you're off the meds, but the recorder picks up the odd blip at times, don't you still need the meds? I would say so, and apparently he/she thinks so as well.

Is it safe to come off the meds? Only a Holter monitor worn for a few weeks or a loop recorder can help you to know that. If a record goes on for some time with no episodes then you can go off the meds. Or, if the recorder does show some runs of AF, you can always start on the Eliquis again.

Is it dangerous to have AF and NOT be on a DOAC (direct-acting oral anticoagulant) like apixaban, rivaroxaban, or dabigatran? Yes, but the latest findings suggest that it's not that critical in the first 20-48 hours. The loop recorder would pick it up, your monitoring agency would text you or call you, and you'd pop the first DOAC pill right away (because you'd always have a small emergency supply, even one tablet in your wallet/purse).

To sum up, you are of the mind that your current medication protects you from AF. It's working. But you haven't had any episodes lately. You'd rather discontinue the drugs, but your cardiologist says you should have a loop recorder to monitor your rhythm 24/7 for at least a year or more, but that it would be safe to go off apixaban at least...for now. This is reasonable and sensible. Without the monitor function, you may still have enough AF, unbeknownst to you, and therefor be at risk of a stroke if you are NOT on a DOAC. Best to have the implant, be monitored, and if you're apparently free of AF, even if only due to the flecainide, then why continue to the DOAC? *

*There is some research suggesting that the danger of dislodged clots from the LAA extends for months for some patients. That is why we have the Watchman. That is why we have some patients stay on apixaban or whatever it is for life, especially if they have other comorbidities that make discontinuing it almost criminal to suggest. But, if your Watchman checks out at the six month mark, usually with a TEE (trans-esophageal echocardiogram), then your risk of a stroke, even with your heart in AF, is very much less than the five times I mentioned earlier.

Just so you know:
A loop recorder is not typically monitored in real-time, meaning it doesn't continuously send every heartbeat signal to a doctor. Instead, it continuously records heart rhythm and only transmits data when it detects an abnormal event or at scheduled intervals, allowing for review later by a healthcare provider; essentially, it acts as a long-term heart monitor that stores data for analysis when needed.
Regards,
Sagan

My husband has a loop recorder and he’s still on Eliquis twice a day. He also had a TIA and the loop recorder he’s had is two years old time to change the battery.

@gloaming I thank you so much for taking the time to write such a detailed response. I didn't mention that I am 74, and I know that AFib is more common at my age than when I was young.
Please let me try to clarify what I was asking. When the doctor mentioned the possibility of a loop recorder a couple of months ago, he said "If you go three years with no AFib while you have the recorder, then I would consider taking you off the Eliquis." But yesterday, when I met with him for the pre-procedure visit, he said, "Once we put the loop recorder in, you can come off the Eliquis." I replied, "But don't I still need the Eliquis in case I "DO" have AFib episodes as those could lead to a stroke?" He said, "But.... you will be being monitored by the loop recorder and any AFib episodes would be reported and if necessary we could put you back on the Eliquis." But.... in MY mind, I'm thinking.... (just as you said in your post above) ... I don't notice the AFib. The doctor said his office will download a report from the monitoring company once a month. What if I have an episode or two the first week.... but the doctor doesn't see the report until the end of each month? If he takes me off Eliquis as soon as I get the loop recorder... that just seems risky to me, because of how the clot may form in the LAA.
My "hope" was that I could have the loop recorder implanted to determine how many episodes of AFib I am having. If I "DO" continue to have these "silent events" that I don't actually notice, but I want to come off the Eliquis (because of the risks also involved in taking it everyday, for example), then I may be considered a candidate for the Watchman so that I could come off the Eliquis.
My main concern here is that the doctor said once he implants the recorder, I will no longer need to take Eliquis because I will be monitored. It would seem more prudent to stay on the Eliquis for a period of time to determine IF and How Often I may be having further AFib events. I hope this makes more sense.... basically, I'm afraid..... Best regards, Mike

@saganjames Thank you for your response! Thus, my concern that once the doctor implants the loop recorder I should not immediately be taken off the Eliquis. It seems it would be more prudent to stay on the Eliquis for at least a certain period of time (the doctor originally said 3 years) to determine IF and how often I may be having other silent AFib events... then make a decision??? Best regards, Mike

@carly14 Thank you for your reply. May I ask, please.... did your husband have any issues other than the TIA that led to the Loop Recorder being implanted? Does he still have episodes of AFib that he doesn't notice but that the Loop Recorder picks up? Obviously, from what you said, HIS cardiologist will replace this loop recorder... so he uses it as a way to constantly monitor your husband's heart? Best wishes! Mike

Yes, it sounds correct. A month of recording your every heartbeat without AFib would indicate that you don’t need a blood thinner because there is no A-Fib present to protect against. Or, if AFib is present, a thinner is necessary.
I have a loop recorder and it is a simple painless procedure that essentially will catch any episode of AFib which arises. I am not aware of its presence- the size of a paperclip under the skin above the muscle.
If the recorder shows AFib- then back onto the thinner for safety from a stroke. At that point, the Watchman would make sense to potentially allow you to go off the thinners. Watchman does not stop Afib, but simply closes off the useless appendage of the atrium from which clots are formed and emerge.
There does seem to be a stroke risk for people who are in and out of AFib without any symptoms. A loop recorder for those patients seems especially useful. If the arrhythmia reappears via the recorder, protective thinners could immediately begin.
Good luck!

@wcuro Hello! You mention that you have a loop recorder. Nothing has been explained to me other than that I will get it and it will transmit data daily to a monitoring system run by the company for my recorder, which is Medtronic. Are you able to check the data somehow yourself on a daily basis? But you are currently not on the blood thinners? So, if you do have an AFib episode that is silent, does the data company notify you right away to go back on the blood thinner? Or are you able to see that, yourself, and resume taking your blood thinner? I'm sorry to sound so confused, but I am.... the EP who diagnosed the AFib and put me on the Eliquis and Flecainide spent all of 5 minutes with me. No explanation. A month later, I switched to another primary cardiologist and he said I didn't need to follow up with the EP and I've been taking the meds ever since. I also have problems with balance, so I am a fall risk... and that concerns me about the Eliquis but I know I need it if I still have AFib.
If you began noticing that you have regular bouts of AFib from the data, would you then consider the Watchman to take care of the LAA problem so you no longer have to take the meds? The cardio's comment was.... "Well, but if you're going to continue taking the thinner, there's no need for the loop recorder." If the loop recorder DOES pick up frequent episodes of silent AFib, I think I would ask to be considered for the Watchman to take care of the LAA problem once and for all.
Sorry.... I know I'm probably making a whole lot out of something that is very insignificant in the grand scheme of things. I really do appreciate you sharing your thoughts! Best regards. Mike

@domiha There is a way to do this that would ostensibly limit your anxiety....which I do NOT discount and feel you are quite right to want to address, Mike. You can adopt the PIP approach (pill-in-pocket) and pop an Eliquis if/once you are apprised by ANY means that you have had more than a very short and self-terminating run of AF. Whether this comes via a loop recorder and a call from your monitoring agency/doctor or whether you sense it because you are symptomatic, or whether your wearable device or Kardia mobile tells you that you have had/are in AF, you have as much as 48 hours to start the anti-coagulation.

Or, you can tell your cardiologist/EP that, all things considered, you would feel a lot better having the loop implanted AND continuing to take at least a month's supply of Eliquis while having no apparent AF, at which you would voluntarily/unilaterally cease taking the DOAC.

@domiha Not insignificant!
You deserve to have your options thoroughly explained and every one of your questions answered. Not the type to press your doctor? Never too late to start. It’s their job! I find understanding medical problems and their potential remedy comforting. Being in the dark is stressful!
I have never had AFib but I do have a different arrhythmia called NSVT- non-sustained ventricular tachycardia- heart beating too fast which can be deadly.
To answer your question, I receive a phone call from the staff( a PA) of my EP’s office when they are notified by the monitoring staff of any heartbeat other than normal. I am asked if I felt anything. I answer no because I have never fainted and have never even felt faint. I am told that being asymptomatic is likely the result of having an otherwise healthy heart with a normal ejection fraction and no blockages based on a myriad of tests I’ve had. Because ventricular tachycardia can be fatal, I not only have a loop recorder, but also a ICD (defibrillator) implanted as an insurance policy. Defibrillators can have two functions: shock the heart back into rhythm if it stops and also a pacemaker function that controls how fast or slowly your heart beats. Depending on the rhythm noted by the recorder, my medication can be tweaked.
Hope this helps. You should consider making an appointment for the purpose of your physician (an EP at a very good hospital) devoting the time for you to learn your options in a relaxed setting without rushing. If your doctor is unwilling, ditch him or her for someone better. It’s work to organize all this, but worth the peace of mind you’ll get in return.