Prospective Single-Centre Experience of a Nurse-Led Chair-Based Pathway for Implantable Loop Recorder Explantation

Implantable loop recorder (ILR) explant has traditionally been performed in catheterization (cath) labs, with bed-based recovery lasting more than 60 min. This conventional model can strain cath lab resources, delay urgent interventional procedures, and inconvenience patients. Currently, there are no standardized guidelines for streamlined ambulatory pathways for ILR removal.

To evaluate the feasibility, safety, and efficiency of a nurse-led, chair-based ambulatory pathway for ILR explant.

A prospective, single-centre quality improvement project was conducted over a 4-month period. Patients were admitted via reception and transferred to a side room, bypassing the cath lab. Explant procedures were performed by trained nurses with consultant oversight available. Post-procedure, patients recovered in a chair in side room for 10-15 min before discharge. Standard wound care and safety instructions were provided. Safety monitoring, efficiency metrics, and patient satisfaction questionnaires were collected. A 201 patients were enrolled in this study. We compared 101 patients who underwent ILR explant through the ambulatory chair-based pathway to 100 patients who underwent consultant-led cath lab- based traditional pathway. In the new nurse-led chair-based pathway, there were no infections, bleeding, or major complications occurred. One case required consultant intervention due to a deep implant. Patient satisfaction was uniformly high, with no complaints reported. Compared to the traditional model, the new pathway reduced cath lab occupancy and bed utilization. Notably, no cancellations occurred during the study period because of cath lab worklaod, whereas in the cath lab era, cases were often delayed or cancelled due to scheduling conflicts with urgent procedures or using cath lab beds as escalation plan.

A nurse-led, chair-based ILR explant pathway is safe, efficient, and highly acceptable to patients. It reduces reliance on cath lab infrastructure, eliminates procedure cancellations, optimizes resource utilization, and has significant implications for reducing waiting list backlogs. This model is reproducible and may inform best practice protocols in other centres.