Abnormal ECG in a 20-Year-Old Female Athlete

History of Present Illness

Chief Complaint: Abnormal electrocardiogram, athletic participation clearance

A 20-year-old university water polo athlete was referred for athletic clearance after an abnormal electrocardiogram (ECG) (Figure 1). She was asymptomatic, with no prior chest pain, shortness of breath, exertional dyspnea, palpitations, or presyncope. She had no family history of cardiovascular disease or sudden death in first-degree relatives.

Figure 1

Figure 1
Figure 1: Pre-participation ECG demonstrating sinus bradycardia (54bpm), incomplete right bundle branch block (RBBB), and non-specific T wave inversions (TWI) in V3-V6 and inferior leads with positive U waves.

Two years prior, she was evaluated for an abnormal ECG. Both stress test and echocardiogram were normal. She was told she had an interventricular conduction abnormality and cleared for full athletic participation.

Currently, she was asymptomatic with a normal physical exam. ECG demonstrated accelerated idioventricular rhythm (AIVR) (Figure 2).

Figure 2

Figure 2
Figure 2: ECG demonstrating AIVR.

Her echocardiogram demonstrated an ejection fraction (EF) of 61%. E/e' ratio and medial e' were 5 and 0.16 meters/second (normal values: <8 and >0.07m/s). Left ventricular (LV) mass index 91g/m2, relative wall thickness 0.40. Indexed LV end diastolic volume (EDV) 56mL/m2 and LV end systolic volume (ESV) 21.8mL/m2.

What is the next best step?

Show Answer