Pleural cavity migration of an implantable loop recorder

Implantable loop recorders (ILR) are relatively novel tools for the diagnosis and clinical management of patients with cryptogenic strokes, syncope and cardiac arrhythmias. The ILR implantation is considered a minimally invasive and low-risk procedure, however rare complications can occur, including device migration. We present the case of a 60-year-old woman who underwent implantation of the new generation ILR BioMonitor III (Biotronik) as part of recurrent syncope workup. The procedure was unremarkable, without acute complications, except for a sharp and persistent chest pain during and after. While at implantation we could activate the device from standard position, we were not able to connect to the device at control after 1 week despite normal functioning of remote monitoring. Chest X-ray and chest computed tomography at one week confirmed device migration into the left postero-inferior part of the pleural cavity. The device was retrieved during thoracoscopy without further complications.