Blinded by the height: A case of telemetry T wave overcounting

High grade atrioventricular (AV) block, defined as 2 or more non-conducted P waves, is a common indication for permanent pacemaker implantation and can be a cause of syncope or presyncope. A 61 year-old male presented to the emergency department with presyncopal symptoms and high grade AV block confirmed on electrocardiogram. Continuous cardiac telemetry monitoring did not trigger any alarm notification during episodes of AV block, due to T wave overcounting. The limitations of telemetry monitoring are rarely recognized and even more rarely reported in the literature.