Incidental Cardiac Arrhythmia Identification With Consumer Grade Heart Rate Monitors: A Case Study

Abstract

HISTORY: A 19-year-old sophomore NCAA Division I female volleyball player was identified, via a consumer-grade heart rate (HR) telemetry system, as having what would be considered a high heart rate (123% of age predicted max HR or 233 bpm) during practice. PHYSICAL EXAMINATION: Athlete was observed without interaction for signs of distress, excessive heavy breathing, pallor changes, or any sort of balance issues that would indicate dizziness or syncope. After approximately 5 minutes, HR returned to a normal level that would be commensurate with the exercises/drills being performed. Once a more in-depth analysis of the collected data was performed it was determined that consultation with team physician and cardiologist was needed. Retrospective analysis of data recorded prior to this episode was undertaken and identified approximately 40% of recorded session contained a similar episode. Further clarification of both HR, and R-R interval data aided in identification of episodes. DIFFERENTIAL DIAGNOSIS: 1. Supraventricular tachycardia (SVT) 2. Wolf-Parkinson-White Syndrome 3. Atrioventricular Nodal Reentrant Tachycardia (AVNRT) TEST AND RESULTS: Electrocardiogram: --No noticeable abnormalities Holter Monitor: --identified an exercise induced SVT episode with no other abnormalities when episode was not present. --HR data was used to assist in identifying duration, initiation and termination of the episode. FINAL/WORKING DIAGNOSIS: Exercise induced SVT TREATMENT AND OUTCOMES: Athlete continued participation with continuous real time heart rate monitoring for episodic activity. When episodes of tachycardia occurred, the athlete was removed from practice/play until a return to normal HR was achieved. After conclusion of academic year an ablation was attempted to correct the problem. The remaining athletes using the HR telemetry system have performance data analyzed on a daily basis for possible identification of arrhythmic signatures. Currently development and implementation of a policy to address identified athletes is underway and will streamline addressing future instances.