Working Diagnosis:
Paroxysmal atrial fibrillation with arrhythmogenic RV cardiomyopathy.

Treatment:
The athlete was treated initially with Metoprolol 12.5mg po bid for rate control which he tolerated well. He has repeated a 30 day event monitor to attempt and delineate SVT vs NSVT or atrial fibrillation. EPS is to be completed to screen for SVT inducibility and if positive will undergo ablation; if negative he will likely have an internal loop recorder placed. ICD placement is still to be considered. His sister has undergone genetic testing which was found to also be positive with no phenotypic changes yet.

Outcome:
Removed from competitive sports and prolonged intense exertion (MPHR <80% for 30 minutes). Without ICD placement, surveillance evaluations recommended annually:
-Cardiac MRI
-Signal average ECG
-ECG
-Exercise stress test
-24 holter monitor (every 6 months)

Editor's Comments:
Italian studies cite that ARVC accounts for 11% of all Sudden Cardiac Death causes in young adults, and 22% in athletes in Italy. Estimated prevalence of 1:1000 to 1:2000 in the general population.
For clarification, the major and minor diagnostic criteria for Arrythmogenic Right Ventricular Cardiomyopathy can be accessed free online with the following citation: Circulation. 2010;121:1533-1541.

References:
1) Diagnosis of Arrythmogenic Right Ventricular Cardiomyopathy/Dysplasia: Proposed modification of the task force criteria. Circulation 2010; 121: 1533-1541.
2) The 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005;45(8)1318-1382.
3) http://emedicine.medscape.com/article/163856-overview#a3

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