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(The Hill) – President Biden has upheld an International Trade Commission (ITC) ruling that could result in an import ban on the Apple Watch, according to AliveCor, a medical device company that has accused Apple of patent infringement.

The California startup said it was informed of Biden’s decision by the Office of the U.S. Trade Representative (USTR) on Tuesday. It’s the first ITC ruling against Apple to clear presidential review.

A USTR spokesperson told The Hill that the decision was made by U.S. Trade Representative Katherine Tai, and noted that presidents typically delegate ITC matters to their top trade official.

The administration’s decision to uphold a potential ban on imports of the tech product sets the stage for a high-stakes legal battle.

The ITC ruled in December that Apple infringed on AliveCor’s wearable electrocardiogram patents. While the commission called for a ban on Apple Watch sales, the order is on hold amid a dispute before the Patent Trial and Appeal Board, which recently ruled that AliveCor’s patents were invalid. 

“This decision goes beyond AliveCor and sends a clear message to innovators that the U.S. will protect patents to build and scale new technologies that benefit consumers,” AliveCor CEO Priya Abani said in a statement. 

Both companies hope to bring the legal issues before an appeals court. The process could take up to 18 months before various orders take effect.

Presidents don’t typically veto ITC decisions. But in 2013, then-President Obama vetoed a potential ban on iPhone and iPad imports after the ITC ruled that Apple infringed on Samsung’s patents. 

Following the most recent ITC ruling, Apple hired the former chairwoman of the ITC to lobby on its behalf, in an apparent effort to secure a presidential veto. The tech giant, along with its allies in Congress, warned that a ban would undermine public health. 

“The patents on which AliveCor’s case rest have been found invalid, and for that reason, we should ultimately prevail in this matter,” Apple said in a December statement. 

The dispute dates back to 2018, when Apple launched Apple Watch models with built-in electrocardiogram sensors, forcing AliveCor to cancel sales of its heart monitoring accessory. AliveCor said that it first shared its technology with Apple in 2015 in an effort to secure a partnership.