APPLE WATCH FAILURE TO RECORD ELECTROCARDIOGRAM FOLLOWING UNIPOLAR LEFT BUNDLE BRANCH AREA PACING

BackgroundWearable devices to monitor heart rhythm allow for rapid correlation of symptoms with ECG. Left Bundle Branch Area Pacing (LBBAP) can be utilized to maintain electrical and mechanical LV synchrony. The limitations of wearable device ECG capture in the setting of LBBAP is not known. We report three cases of patients who reported failure of Apple Watch (AW) ECG recording following implantation of LBBAP systems.NarrativePatient 1 presented with symptomatic AV block and LVEF of 45%. A LBBAP system (Medtronic 3830 lead) was implanted set to unipolar ventricular pacing. LB capture was confirmed on 12 lead ECG demonstrating a terminal R wave in lead V1 and short LV activation time in leads V5/V6 at high and low output pacing. At follow up, the patient reported that his AW ECG stopped functioning following pacemaker implant. While in the office, the watch repeatedly reset itself every second and failed to record (Figure 1). When pacing polarity was programmed to bipolar, the AW ECG recording was successful.Patient 2 underwent a successful implantation of LBBAP (Biotronik Solia S lead) programmed to unipolar ventricular pacing. At a follow up visit, the patient reported failure of his AW ECG system to record. Following reprogramming to bipolar pacing, the watch could record ECG tracings.Patient 3 underwent LBBAP implantation with a 3830 lead set to unipolar pacing and reported failure of his AW to record an ECG. Reprogramming to bipolar pacing resulted in anodal capture with prolongation of left ventricular activation time. While unipolar pacing, a KardiaMobile 6L system successfully recorded an ECG. (Figure 2)ConclusionSuccessful KardiaMobile 6L system ECG recording.View Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundWearable devices to monitor heart rhythm allow for rapid correlation of symptoms with ECG. Left Bundle Branch Area Pacing (LBBAP) can be utilized to maintain electrical and mechanical LV synchrony. The limitations of wearable device ECG capture in the setting of LBBAP is not known. We report three cases of patients who reported failure of Apple Watch (AW) ECG recording following implantation of LBBAP systems. Wearable devices to monitor heart rhythm allow for rapid correlation of symptoms with ECG. Left Bundle Branch Area Pacing (LBBAP) can be utilized to maintain electrical and mechanical LV synchrony. The limitations of wearable device ECG capture in the setting of LBBAP is not known. We report three cases of patients who reported failure of Apple Watch (AW) ECG recording following implantation of LBBAP systems. NarrativePatient 1 presented with symptomatic AV block and LVEF of 45%. A LBBAP system (Medtronic 3830 lead) was implanted set to unipolar ventricular pacing. LB capture was confirmed on 12 lead ECG demonstrating a terminal R wave in lead V1 and short LV activation time in leads V5/V6 at high and low output pacing. At follow up, the patient reported that his AW ECG stopped functioning following pacemaker implant. While in the office, the watch repeatedly reset itself every second and failed to record (Figure 1). When pacing polarity was programmed to bipolar, the AW ECG recording was successful.Patient 2 underwent a successful implantation of LBBAP (Biotronik Solia S lead) programmed to unipolar ventricular pacing. At a follow up visit, the patient reported failure of his AW ECG system to record. Following reprogramming to bipolar pacing, the watch could record ECG tracings.Patient 3 underwent LBBAP implantation with a 3830 lead set to unipolar pacing and reported failure of his AW to record an ECG. Reprogramming to bipolar pacing resulted in anodal capture with prolongation of left ventricular activation time. While unipolar pacing, a KardiaMobile 6L system successfully recorded an ECG. (Figure 2) Patient 1 presented with symptomatic AV block and LVEF of 45%. A LBBAP system (Medtronic 3830 lead) was implanted set to unipolar ventricular pacing. LB capture was confirmed on 12 lead ECG demonstrating a terminal R wave in lead V1 and short LV activation time in leads V5/V6 at high and low output pacing. At follow up, the patient reported that his AW ECG stopped functioning following pacemaker implant. While in the office, the watch repeatedly reset itself every second and failed to record (Figure 1). When pacing polarity was programmed to bipolar, the AW ECG recording was successful. Patient 2 underwent a successful implantation of LBBAP (Biotronik Solia S lead) programmed to unipolar ventricular pacing. At a follow up visit, the patient reported failure of his AW ECG system to record. Following reprogramming to bipolar pacing, the watch could record ECG tracings. Patient 3 underwent LBBAP implantation with a 3830 lead set to unipolar pacing and reported failure of his AW to record an ECG. Reprogramming to bipolar pacing resulted in anodal capture with prolongation of left ventricular activation time. While unipolar pacing, a KardiaMobile 6L system successfully recorded an ECG. (Figure 2) Conclusion