A 16-year-old Caucasian national level cyclist underwent a cardiac evaluation organised by a charity organisation. He attended on a voluntary basis after a fellow cyclist suffered a sudden cardiac arrest during a race in 2013.
- He was asymptomatic at the time and there was no relevant family history of premature cardiovascular disease or sudden cardiac death.
- His ECG (Figure 1) showed sinus bradycardia with T-wave inversion in leads V1-V3, borderline prolonged S wave duration of 55 msec in V2 and the possibility of an Epsilon wave in lead V1.
Figure 1: ECG 2013
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- Sharma S, Drezner JA, Baggish A, et al. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol. 2017;69(8):1057 LP-1075. doi:10.1016/j.jacc.2017.01.015.
- Lie OH, Dejgaard LA, Saberniak J, et al. Harmful Effects of Exercise Intensity and Exercise Duration in Patients With Arrhythmogenic Cardiomyopathy. JACC Clin Electrophysiol. 2018;4(6):744-753. doi:10.1016/j.jacep.2018.01.010.
- Ruwald A-C, Marcus F, Estes NAM 3rd, et al. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J. 2015;36(27):1735-1743. doi:10.1093/eurheartj/ehv110.
- Saberniak J, Hasselberg NE, Borgquist R, et al. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail. 2014;16(12):1337-1344. doi:10.1002/ejhf.181.
- James CA, Bhonsale A, Tichnell C, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol. 2013;62(14):1290-1297. doi:10.1016/j.jacc.2013.06.033.
- Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010:243-259. doi:10.1093/eurheartj/ehp473.
- Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121(13):1533-1541. doi:10.1161/CIRCULATIONAHA.108.840827.
- Finocchiaro G, Papadakis M, Dhutia H, et al. Electrocardiographic differentiation between “benign T-wave inversion” and arrhythmogenic right ventricular cardiomyopathy. Eur Eur pacing, arrhythmias, Card Electrophysiol J Work groups Card pacing, arrhythmias, Card Cell Electrophysiol Eur Soc Cardiol. 2019;21(2):332-338. doi:10.1093/europace/euy179.
- Pelliccia A, Solberg EE, Papadakis M, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2018;40(1):19-33. doi:10.1093/eurheartj/ehy730.
- Samol A, Wollmann C, Vahlhaus C, et al. T-wave integral : an electrocardiographic marker discriminating patients with arrhythmogenic right ventricular cardiomyopathy from patients with right ventricular outflow tract tachycardia. 2013:582-589. doi:10.1093/europace/eus311.
- Zaidi A, Sheikh N, Jongman JK, et al. Clinical differentiation between physiological remodeling and arrhythmogenic right ventricular cardiomyopathy in athletes with marked electrocardiographic repolarization anomalies. J Am Coll Cardiol. 2015;65(25). doi:10.1016/j.jacc.2015.04.035.
Notes to editor
Dr Gati, Sabiha. Lister Hospital, East & North Hertfordshire NHS Trust.
Prof Sharma, Sanjay, St. George’s, University of London