The ILR was explanted in September of 2015 and the patient has remained asymptomatic for 9 months since the procedure.
He returned to athletic participation and continued monitoring with the ILR. The patient subsequently underwent a successful radiofrequency ablation procedure. The loop recorder was then interrogated, which confirmed a wide variable complex arrhythmia nearly identical in appearance to what had been recorded during the previous symptomatic event ( Figure 1). This pacing produced atrioventricular re-entrant tachycardia (AVRT) with aberrancy. An isoproterenol infusion was started and SVT was induced using atrial burst pacing. Ventricular pacing revealed the presence of a left posterior accessory pathway. (B) The aberrant arrhythmia that was induced in the EP laboratory while the patient was supine was simultaneously recorded by the ILR and showed a wide complex QRS configuration.ĭuring the EP study (performed under conscious sedation), catheter manipulation induced SVT the patient confirmed that the symptoms during SVT at EP study matched the symptoms of his clinical episodes found on the ILR. The trigger for the event was “back flips,” correlating with the brief bradycardia (squatting down prior to jumping) and artifact (due to the impact of landing after the jump). This was found on the original loop recorder tracings (standing). The loop recorder data and EP study data are shown in Figure 1.įigure 1: (A) The 44-beat run of wide complex tachycardia and the mechanically induced noise that preceded it. The differential diagnosis was supraventricular tachycardia (SVT) with aberrancy versus ventricular tachycardia (VT). An electrophysiology (EP) study was performed to determine the possible etiology. The second event was 44 beats in duration, ranging between 220 and 240 bpm. Both events were wide variable complex tachycardia that was preceded by bradycardia. Within 1 month of implantation he manually triggered the device during his practice and two episodes of tachycardia were detected during the 8-minute transmission. Due to the difficulty in obtaining event recordings during practice, an ILR (Medtronic Linq, Minneapolis, MN) was placed. The first patient is a 21-year-old collegiate diver who presented with recurrent infrequent palpitations that occurred while performing training exercises. The ILR proved useful in the accurate diagnosis and appropriate management of both athletes, underscoring the value of these devices in this special population.
This case report highlights the diagnostic value of an implantable loop recorder (ILR) in two elite athletes, one with recurrent palpitations, the other with a history of bradycardia and syncope. 1 Thus, prompt evaluation of an athlete with a possible arrhythmia as the cause is warranted. Sudden cardiac arrests in athletes are high-profile events and the risk of sudden cardiac arrest has been shown to be greater in athletes versus the general population. Manuscript received March 14, 2016, Final version accepted May 9, 2016.Īddress correspondence to: Ian Law, MD: Stead Family University of Iowa Children’s Hospital, 200 Hawkins Drive, Iowa City, IA 52242–1083. The authors report no conflicts of interest for the published content. loop recorders, supraventricular tachycardia, ventricular tachycardia. In both instances, the ILR facilitated a diagnosis, which ultimately lead to appropriate and timely management. Here we highlight the value of the implantable loop recorder (ILR) using two cases involving collegiate athletes. In order to reduce mortality without unnecessarily taking healthy athletes away from competition, a useful diagnostic test is needed. Sudden cardiac arrests in athletes due to arrhythmias have become much more high profile, and the relative risk of sudden cardiac death has been shown to be greater in athletes when compared to non-athletes. The University of Iowa Children’s Hospital, Division of Pediatric Cardiology, Iowa City, IAĪBSTRACT.
A Tale of Two Athletes: The Value of Implantable Loop Recorders in Elite AthletesĪNDREW HULL, BS, FRANK CANADY, BA, PRASHANT BHAVE, MD and IAN LAW, MD
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