PO-04-083 NOT EVERYTHING IS AS IT SEEMS

Personal wearable devices capable of recording a single lead ECG have been found to be very useful in detecting arrhythmias with and without symptoms. To describe case from Apple watch (AW) that nearly implantable cardioverter defibrillator (ICD) implant N/A A 36-year-old female long history palpitations episodes sudden onset rapid regular tachycardia associated lightheadedness, presyncope are unresponsive Valsalva maneuvers lasting for few minutes at time. Mobile cardiac outpatient telemetry unremarkable due lack symptoms during the period. She obtained an AW feeling “off” recorded frequent premature ventricular complexes (PVCs-Panel A). Two week extended holter following this event was again unremarkable, <1% PVC burden but typical periods bigeminy. Several months later, she had recurrent episode enough (∼5 minutes) obtain recordings wide complex (WCT-Panel B) rate >200 bpm. instructed go ED admitted. Work up included echocardiogram left ejection fraction (LVEF) 62% no other obvious structural abnormalities. Cardiac magnetic resonance imaging (cMRI) consistent acute or resolving myocarditis versus sarcoidosis. Sarcoid PET scan inflammation active sarcoidosis myocarditis. Stress test sustained arrhythmias. Given WCT bpm symptomatic near syncope setting heart disease (cMRI delayed enhancement myocarditis), discussion ensued regarding further evaluation treatment, including consideration ICD. decision made move forward electrophysiologic study (EPS) possible PVC/ventricular (VT) ablation. During EPS inducible atrio-ventricular reentrant (AVNRT) right bundle branch block aberration (Panels C D) similar as her clinical arrhythmia. Monomorphic VT not stimulation on off isoproterenol, therefore ICD implanted. AVNRT treated slow pathway modification. While tracings personal such can provide information symptom-arrhythmia correlation, must vetted rigorously avoid misdiagnosis which mistreatment.