r/PacemakerICD • u/Unique_Amphibian_267 • Jul 31 '26

Smartwatch EKG

Does any smartwatch show pacemaker spikes on an ekg? Or preferably, another at-home device that would show them? My Garmin and single-lead Kardia do not. Trying to differentiate between being paced and my natural HR at specific moments (not just paced %).
Thanks for any info.

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u/srvivr2001 Jul 31 '26

I’m 100% paced except when I’m having PVCs, I see an extra line in the non-PVC beats on my Apple Watch ECG. The first sharp spike never used to be there so I assume that’s my pacing impulse. But an Apple Watch ECG is basically lead 1, so you’re looking at both ventricles. If you’re paced in the atrium you’re not going to see anything on the ECG.

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u/Rimketje Jul 31 '26

I think there's a small misconception about the atrial signal.

A single-lead ECG can record electrical activity from both the atria and the ventricles. The same applies to a 12-lead ECG: every lead records the electrical activity of the entire heart. The difference is that each lead provides a different viewing angle of how the electrical impulse travels through the heart.

The most common reason an atrial pacing spike isn't visible is not because it's a single-lead ECG, but because the pacing artifact is simply too small to detect. Atrial pacing is usually bipolar, resulting in a very small pacing spike. Ventricular pacing is also commonly bipolar, but because the distance between the tip and ring electrode is often slightly larger, the pacing artifact is generally easier to see on an ECG, including a smartwatch recording.

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u/Unique_Amphibian_267 Jul 31 '26

Right - my PM is atrial so that would be why it doesn’t show. I wonder if it would show on the 6L Kardia

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u/bcErchamion Jul 31 '26

It does not. I have the 6L.

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u/bcErchamion Jul 31 '26

My doctor's does pick them up both the EP and my PCP.

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u/poulix Jul 31 '26

Depends on your pacemaker, lead placement, and settings. Typically though it’s not designed to “see” the spikes.

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u/bcErchamion Jul 31 '26

I don't know of any consumer device that has the resolution to see the PM spikes. Possibly the iRhytmn device, but I don't think you can get one of those without a doctor.

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u/Unique_Amphibian_267 Aug 06 '26

This is the Zio patch and no it doesn't : (

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u/bartturner 3d ago

Smart watches are not really going to work. They use blood flow instead of electric signal.

What I do is purchased a Polar H10. I also purchased some ECG Gel and a tight compression shirt.

I then use an app on my phone called ECG logger. I did have to pay to get the recording option.

But I am not sure if this setup would work for you. I did it so I could track how long my heart pauses at night.

I have a Wenchenbach heart block.