AbstractBackgroundRemote monitoring is recommended for patients with implantable cardiac monitors (ICMs), but compared to other cardiac implantable devices, ICMs are less accurate and transmit a higher number of alerts.ObjectiveThe aim of this study was to investigate the predictors of false‐positive (FP) arrhythmic alerts in patients with unexplained syncope who were implanted with ICM and followed by an automatic remote monitoring system.MethodsWe retrospectively evaluated all consecutive patients who received a long‐sensing vector ICM for unexplained syncope between January 2019 to September 2021 at our Syncope Unit. The primary endpoint was the incidence of the first FP episode. The secondary endpoints included assessing the incidence of FP episodes for all types of algorhythms and indentifying the reasons for the misdetection of these episodes.ResultsAmong 105 patients (44.8% males, median age 51 years), 51 (48.6%) transmitted at least one FP alert during a median follow‐up of 301 days. The presence of pre‐ventricular complexes (PVCs) on the resting electrocardiogram was the only clinical characteristic associated with an increased risk of FP alerts (adjusted Hazard ratio [HR] 5.76 [2.66–12.4], p = 0.010). The other significant device‐related variables were a low‐frequency filter at 0.05 Hz versus the default 0.5 Hz (adjusted HR 3.82 [1.38–10.5], p = 0.010) and the R‐wave amplitude (adjusted HR 0.35 [0.13–0.99], p = 0.049).ConclusionPatients who have PVCs are at higher risk of inappropriate ICM activations. To reduce the occurrence of FP alerts, it may be beneficial to target a large R‐wave amplitude during device insertion and avoid programming a low‐frequency filter at 0.05 Hz.