A 17 years old competitive cyclist was implanted a loop recorder due to premature ventricular contractions which increase during exertion. At maximum exertion during stress testing he developed ventricular bigeminy.
No history of syncope. No family history of sudden cardiac death or arrhythmia syndromes.
One year following implantation the ILR reported the following tracing:
There is ventricular bigeminy, followed by couplets. Finally ventricular tachycardia initiates with broad QRS and varying cycle lengths. Overall the appearance of the tachycardia seems quite fast and irregular. Thus this is not "usual" right ventricular outflow tract VT with regular cycle lengths, which may appear in athletes.
We therefore scheduled the patient for electrophysiologic study to perform risk stratification. We also await genetic testing results, since arrhythmogenic cardiomyopathy (ACM) or catecholaminergic polymorphic ventricular tachycardia (CPVT) are among differential diagnoses.
We will update the case in future blogs as we receive genetics results and performed EP study.