Undetected supraventricular tachycardia causing congestive heart failure: a pitfall of remote monitoring system

Remote monitoring systems with automated clinician alerts are a milestone development for implantable cardiovascular devices, and improve the quality of life for patients and physicians by reducing the number of conventional clinic visits. In addition, remote monitoring systems can detect many bradyarrhythmias and tachyarrhythmias earlier than traditional methods, although these devices are not perfect. We report the case of an 80-year-old woman with an implanted pacemaker and a remote monitoring system that failed to report acute heart failure at 10 months after implantation. ECG and telemetry revealed relatively slow supraventricular tachycardia, which did not trigger the alert, and catheter ablation successfully controlled the heart failure. Subsequent analysis revealed that the monitoring function had detected the arrhythmia as frequent premature ventricular contraction, although the arrhythmia did not trigger the automated clinician alert. Therefore, remote monitoring systems with accurate settings are essential, although conventional monitoring methods are still important for some patients.