Life-Saving Intervention Through Real-Time Continuous Cardiac Monitoring: A Case of Tachy-Brady Syndrome Detection and Emergency Management

Atrial fibrillation (AF) is a common arrhythmia associated with a high risk of thromboembolic events, particularly in older adults.When coexisting with conduction system disease, such as atrioventricular (AV) block or sinus node dysfunction, the risk of syncope, heart failure, and sudden cardiac death increases significantly.A 72-year-old male with a history of AF, hypertension, and hyperlipidemia was referred for evaluation of recurrent dizziness and syncope.He was on anticoagulation therapy with apixaban and antihypertensive medications.A 14-day real-time continuous EKG monitor (Bittium Faros™ 360, Bittium Biosignals Ltd., Kuopio, Finland) revealed persistent AF with 3,199 ventricular pauses, the longest lasting 6.6 seconds and unaccompanied by reported symptoms, in addition to advanced AV conduction disease without documented ventricular tachyarrhythmias.These findings were consistent with tachy-brady syndrome.Given the substantial bradyarrhythmic burden and risk of asystole, urgent referral for permanent pacemaker (PPM) implantation was made.The patient underwent successful PPM implantation during emergency admission.He remained on apixaban and antihypertensives post-procedure and reported no recurrence of symptoms during follow-up.This case illustrates the diagnostic yield of extended real-time continuous cardiac monitoring in detecting a high burden of clinically silent bradyarrhythmia and in supporting timely intervention in patients with AF and conduction system disease.