Case ReportContribution of remote monitoring to the early diagnosis of implantable cardioverter-defibrillator shocks in the patient with cardiac resynchronisation therapy

We present the case of a 68-year-old man with coronary artery disease and a history of recurrent myocardial infarctions, having left ventricular ejection fraction 25% in NYHA functional class III. The patient received a biventricular cardioverter-defibrillator (ICD) Biotronik Lumax 340 HF-T in November 2008 from the primary prophylactic indication. Remote monitoring using the Biotronik Home Monitoring™ (HM) system was activated since device implantation. Up to April 2012 the patient received five shocks including 3 appropriate VF therapies and 2 inappropriate ICD shocks (due to T-wave oversensing and atrial flutter degenerating to VF after ATPs). All arrhythmic events were promptly detected by the HM system with a rapid consequent pharmacological and non-pharmacological intervention (radiofrequency catheter ablation of atrial arrhythmia and reprogramming the device). This case points out that prophylactic ICD implantation is a justifiable method for the prevention of arrhythmic death in high-risk patients and HM significantly helps in the early recognition of inappropriate ICD therapy.