Intrathoracic Fluid Monitoring System (OptiVol) Proved Useful for Earlier Detection of Heart Failure (HF) and Asymptomatic Electrical Storm of Slow VT: A Case Report

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We report a case of 78-year-old man with dilated form of hypertrophic cardiomyopathy. An ICD (Secura, Medtronic Inc.) was implanted for drug-resistant ventricular tachycardia (VT). He received remote home monitoring system (CareLink) including intrathoracic fluid monitoring system (OptiVol). On December 9, 2010, he suffered from general fatigue, but did not have any symptom due to VT. At midnight on December 15, the OptiVol alert due to severe increase of OptiVol fluid index was automatically transmitted. On the next day, we received the alert. In the transmitted data, we found that 85 episodes of sustained VT (mean HR 143 bpm) had occurred and antitachycardia pacing (ATP) was performed 243 times for the VT since December 9. He was diagnosed as HF due to electrical storm of slow VT and admitted emergently on the same day. He received medical treatment for HF and VT. Eventually, he underwent RFCA for VT because of resistance to medication. Finally, we succeeded in terminating the VT by RFCA and improving HF. He had asymptomatic electrical storm of VT, which developed into HF. In this case, the OptiVol alert provided the earlier detection of HF and consequently gave a chance to find out the asymptomatic electrical storm of slow VT resistant to repeated ATP.