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Vol. 73. Issue 11.
Pages 952 (November 2020)
ECG Contest
DOI: 10.1016/j.rec.2020.03.024
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Response to ECG, October 2020
Respuesta al ECG de octubre de 2020
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Francisco Ribes
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fribestur@gmail.com

Corresponding author:
, Ángel Martínez-Brótons, Ricardo Ruiz-Granell
Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Rev Esp Cardiol. 2020;73:84710.1016/j.rec.2020.03.023
Francisco Ribes, Ángel Martínez-Brótons, Ricardo Ruiz-Granell
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The correct solution is number 4. Palpitations and exercise-induced presyncopal sensation, along with frequent ventricular extrasystoles and repolarization changes in the right precordial leads, is a strong indicator of arrhythmogenic cardiomyopathy. Gadolinium uptake in the right ventricular free wall is associated with a particularly serious condition and risk of sudden cardiac death.1 Progressive onset of tachycardia is observed during exercise with a sharp decrease in cycle length once tachycardia becomes established (response 1, incorrect). Tachycardia presents with pleomorphism and, after several beats, becomes regular (response 2, incorrect). Finally, the cycle length (260-270ms) is not typical of atrial flutter (response 3, incorrect). Genetic testing was performed. Heterozygous PKP2 mutation, which is typical of arrhythmogenic cardiomyopathy, was detected. A dual-chamber defibrillator was implanted,2 and treatment initiated with sotalol. Genetic screening of family members was performed and exercise was contraindicated.

References
[1]
A. Pelliccia, D. Corrado, A. Bjørnstad, et al.
Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis.
Eur J Cardiovasc Prev Rehabil., 13 (2006), pp. 876-885
[2]
D. Corrado, H. Calkins, M.S. Link, et al.
Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/displasia and no prior ventricular fibrillation or sustained ventricular tachycardia.
Circulation., 122 (2010), pp. 1144-1152
Copyright © 2020. Sociedad Española de Cardiología
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