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Off The Stroke Rate: Tachyarrhythmia In A Collegiate Rower - Page #3
 

Lab Studies:
Standard metabolic and hematologic workup performed in the fall was unremarkable. Electrolytes including potassium and magnesium were within normal limits. Thyroid-stimulating hormone was not repeated at that visit; prior thyroid function testing from the previous fall was within normal limits.

Other Studies:
Home cardiologist:
Resting 12-lead electrocardiogram demonstrated sinus rhythm, rate 73 bpm with minor anterior T-wave changes in leads V2 through V3 and no pre-excitation.
Case Photo #2
Transthoracic echocardiogram demonstrated normal chamber size and systolic function with no atrial septal defect on color Doppler.
Fall sports physical:
Repeat electrocardiogram was normal. Holter monitor captured one episode of tachycardia during rowing.
Case Photo #3
Given ongoing symptom burden and athlete preference for definitive diagnosis and resolution, electrophysiology study was performed.
The arrhythmia was non-inducible at baseline; following isoproterenol infusion, 8 to 10 complexes of atrioventricular nodal re-entrant tachycardia were induced. Short ventriculoatrial interval of 0 milliseconds and stimulation-to-atrial interval minus ventriculoatrial interval exceeding 115 milliseconds confirmed typical slow-fast atrioventricular nodal re-entrant tachycardia.

Consultations:
Given the wearable data, prior external workup, and continued frequency of episodes, sports medicine referred her to the electrophysiology service at our institution for further evaluation and management. Mapping and catheter ablation were subsequently performed by electrophysiology, with sports medicine co-managing the return-to-sport protocol.

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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