Atypical presentation of false asystole detection in implantable loop recorder

Description

A 57-year-old male patient was admitted for evaluation of pacemaker explantation 7 years after implantation because of paroxysmal complete atrioventricular (AV) block due to presumed lyme carditis. In view of a stable ventricular pacing rate of <1%, complete removal of the system without reimplantation was considered. An electrophysiological study revealed normal AV conduction and normal AVBCL (atrioventricular block cycle length). Therefore, pacemaker removal and lead extraction were scheduled, the pacemaker was set to a VVI 30/min mode and a newer generation implantable loop recorder (ILR, Medtronic Reveal LINQ, Medtronic, Dublin, Ireland) was implanted for remote monitoring of the patient's heart rhythm. At a regular outpatient visit 2 weeks later, the ILR indicated an episode of asystole over 7.8 s (figure 1) during the daytime 1 day after ILR implantation. The patient did not report any symptoms at that time. Pacemaker interrogation showed appropriate function. The episode was hence considered erroneous asystole...

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