Working Diagnosis:
Intermittent Atrial Tachycardia

Treatment:
Given that athlete's rhythm seemed to improve to sinus tachycardia with exertion, he was encouraged to exercise with explicit warning signs and symptoms.
Had elective EP mapping study with ablation at left atrial ridge atrial tachycardia focus. Full recovery and returned to training and competition at elite levels without difficulty or need for medication or additional procedures.
Cardiology and team physicians for continued monitoring of symptoms and vitals.

Outcome:
Athlete is doing well and back to competitive levels.

Author's Comments:
This case highlights why we do PPEs. This was a VERY high-functioning athelete with no real complaints just “following the rules” and came in for his required PPE. I detected his tachycardia with an irregularly irregular pulse, which ultimately let to a successful treatment and safe return to play.

Editor's Comments:
A through history and most importantly cardiac exam helped to diagnosis an underlying cardiac condition in this athlete.
Paroxysmal supraventricular tachycardia (PSVT) is a narrow QRS complex tachycardia and can account for intermittent episodes of supraventricular tachycardia.
Electrophysiologic studies are usually necessary to determine the pathophysiology of impulse formation and pathways of conduction.
When determining eligibility for participation with cardiac concerns review of the AHA/ACC guidelines is recommended.

References:
Hafeez Y, Grossman SA. Paroxysmal Supraventricular Tachycardia. 2020 Sep 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29939521.

Eligibility and Disqualification Recommendations for Competitive Athletes with Cardiovascular Abnormalities: A Scientific Statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015;Nov 2:

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