Working Diagnosis:
Exercise associated sudden cardiac arrest
Idiopathic ventricular fibrillation

Treatment:
Based on the history of syncopal event and the patient’s diagnosis, ICD was again recommended and was placed at Mayo Clinic. The patient’s entire genome, as well as that of his close family members, was sequenced. To date, no mutations explaining the patient’s diagnosis have been identified.

Outcome:
The patient and his family underwent extensive counseling at Mayo Clinic. They were advised of the 36th Bethesda Conference Guidelines and were provided with a copy of these recommendations. They were counseled on the patient’s diagnosis and how current guidelines recommend no further participation in competitive athletics (2). They were also informed of a current, on-going registry at Mayo Clinic which consists of 130 athletes with Long QT Syndrome (20 with ICDs) who are participating against the 36th Bethesda Conference Guidelines (1). He was provided with medical clearance by Mayo Clinic physicians for return to competitive basketball participation. However, despite these recommendations, local cardiologists, team physicians, athletic training staff, university officials, and coaching staff were uncomfortable with a return to competitive athletics. The patient was declared medically ineligible. He has since returned to aerobic activity and recreational basketball outside of university facilities. He is currently investigating opportunities to play basketball at another institution.

Editor's Comments:
This was a dramatic save, and it is gratifying to see the institution's emergency plan worked so well.

This is the athlete that EKG screening programs are looking for. One assumes from the way this case reads that EKG was not part of his preparticipation cardiac clearance, and one hopes that if screening were done that he would have been flagged for additional testing.

References:
1. Johnson, Jonathan N., and Michael J. Ackerman. "Return to play? Athletes with congenital long QT syndrome." British journal of sports medicine 47.1 (2013): 28-33.

2. Maron, Barry J., Douglas P. Zipes, and M. J. Ackerman. "36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities." J Am Coll Cardiol 45.8 (2005): 1311-75.

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