Working Diagnosis:
Arrhythmogenic right ventricular dysplasia (ARVD).

Treatment:
An automatic implantable cardiac defibrillator (AICD) was placed.
Genetic testing is pending.

Outcome:
He was instructed to avoid endurance exercise or any activities that keep his heart rate up for extended periods of time. Three months from initial presentation, diagnosis and AICD placement, he was assisting with high school football game coverage.

Author's Comments:
The prevalence of ARVD is estimated to be roughly 1:5000. Regarding sports-related sudden cardiac deaths, ARVD is thought to account for 22% to 27% in Europe and roughly 10% to 15% of all sudden cardiac deaths (SCD). There is known high prevalence in Italy. However, our patient is of Dutch descent which ARVD in his age group had been found to account for only 5% of all SCD. These cases are difficult given that initial manifestation of ARVD is often SCD. As such, debate has been made regarding ECG screening as part of pre-participation exams, but Asif et al. noted that lack of proper infrastructure has made implementation in the United States difficult. However, it was noted that targeted ECG screening of high risk athletes may be beneficial when adequate resources are available. Regardless of ECG screening availability we believe it is important to get a thorough cardiac history and keep ARVD in the differential when a young athlete presents with palpitations and seemingly unremarkable PMH.

References:
1.) Asif, Irfan M., and Kimberly G. Harmon. "Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments." Sports Health: A Multidisciplinary Approach, vol. 0, no. 3, 2017, pp. 268-279., doi:10.1177/1941738117694153.
2.) Corrado, Domenico, et al. "Arrhythmogenic Cardiomyopathy." Circulation Research. Journal of the American Heart Association, 15 Sept. 2017, pp. 784-802., doi: 10.1161/CIRCRESAHA.117.309345
3.) Sadjadieh, Golnaz, et al. "Nationwide (Denmark) Study of Symptoms Preceding Sudden Death Due to Arrhythmogenic Right Ventricular Cardiomyopathy." The American Journal of Cardiology, vol. 113, no. 7, 2014, pp. 1250-1254., doi: 10.1016/j.amjcard.2013.12.038

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