17-Year-Old Multi-Sport Athlete Has a Cardiac Arrest During Competition

A 17-year-old multi-sport high school athlete and captain of the lacrosse team collapses on the soccer field during active play. The trainer immediately goes to him, identifies him as unresponsive and pulseless, then promptly begins cardiopulmonary resuscitation (CPR) and quickly applies an automated external defibrillator (AED). The tracing (Figure 1) documents ventricular fibrillation. He is shocked three times and has return of circulation. He is admitted to the hospital intubated, undergoes a cooling protocol, and has a full recovery. The hospital electrocardiogram (ECG) and magnetic resonance imaging (MRI) are seen in (Figure 2, Figure 3). The electrophysiologist reports to the family that the diagnosis is commotio cordis, and he is discharged on no medication and without implantable cardioverter-defibrillator (ICD). Two weeks later he undergoes an evaluation with the family requesting cardiac clearance for return to play. His ECG and echocardiogram from the outpatient visit are seen in (Figure 4, Figure 5).

Which of the following is the next step in the management for this patient?

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