Episodes Of Tachycardia Captured On Athlete’s Smartphone ECG - Cricket

Abstract

HISTORY: An elite male cricketer aged 16 years experienced episodes of palpitations. These lasted 10-120 seconds, and occurred every 2 weeks over 9-12 months, usually between bouts of submaximal exercise at training. PHYSICAL EXAMINATION: Subsequent clinical examination showed sinus bradycardia. Blood pressure was normal, heart sounds dual (no murmur), chest examination clear with no peripheral oedema. DIFFERENTIAL DIAGNOSIS: 1. Atrial fibrillation 2. Paroxysmal supraventricular tachycardia (SVT) 3. No arrhythmia (non-cardiac cause) TEST AND RESULTSBaseline electrocardiogram (ECG), echocardiogram, 24-hour and 3-day Holter monitor were normal. The athlete purchased a smartphone single lead ECG (iECG) and captured a trace confirming paroxysmal SVT (206bpm) during an episode of symptoms. FINAL/WORKING DIAGNOSIS: Paroxysmal SVT. Dual atrioventricular (AV) nodal pathways, AV junctional re-entrant tachycardia. TREATMENT AND OUTCOMES The athlete had an electrophysiology study and ablation (slow pathway modification procedure), which was repeated 9 months later due to an incomplete response. This deferred the need for medication which could impact exercise capacity. At age 19, the athlete experienced symptoms on 2 occasions at maximal exertion levels. Both lasted 5 minutes, with an irregular arrhythmia and light-headedness, but no chest pain or shortness of breath. The athlete purchased an iECG (having misplaced the old one) and recorded traces showing a wide complex tachycardia (196bpm), likely SVT with aberrancy. The athlete had a further electrophysiology study which showed persisting dual AV nodal pathway physiology but concurrently a left sided posteroseptal concealed bypass tract, requiring a third ablation. He has returned to elite sport after a brief period off. This case demonstrates the utility of an iECG as the athlete was able to capture the arrhythmias, which aided in diagnosis where traditional monitoring could not detect an abnormality.