An 11-Year-Old Athlete Presents After Witnessed Cardiac Arrest at Football Practice
A previously healthy 11-year-old male presents after a witnessed cardiac arrest during a non-contact football practice. He was lining up for a play and suddenly dropped to the ground. There was no preceding trauma. An automated external defibrillator was placed and demonstrated a non-shockable rhythm. After several rounds of bystander CPR, a shockable rhythm was detected, and return of spontaneous circulation (ROSC) was achieved. Upon arrival to the hospital, his neurologic examination demonstrated no spontaneous movement, no breaths over the ventilator rate as well as absent gag reflex. His post-arrest electrocardiogram (ECG) was significant for sinus tachycardia and ST depression in the inferolateral and anterolateral leads. His echocardiogram showed a structurally normal heart with a mild to moderately dilated left ventricle with moderately depressed systolic function. His coronary artery origins were normal (Figure 1).
In a pediatric patient in whom an immediate cardiac cause for sudden arrest is not delineated following ECG and echocardiogram, what is the next best test to perform?