Flipping syncope: The case of an adolescent athlete with syncopal episodes ultimately diagnosed with catecholaminergic polymorphic ventricular tachycardia

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  FIGURE 1. Presenting rhythm is sinus @ 89 bpm. Patient family called to notify us that the patient had an episode after dismounting from doing handstands and that they activated her loop recorder. Review of the activations shows that the device also autotriggered at this time as well for tachycardia. There is some muscle/motion artifact noted on the tracings, but the initial rhythm appears to be sinus with occasional PVCs, after a significant amount of what appears to be noise rhythm is consistent with VF which lasts approximately 90 s and spontaneously breaks into sinus bradycardia with frequent PVCs including s

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  FIGURE 2. Exercise treadmill test ECG. Resting ECG was sinus rhythm (A). With onset of activity, she began to have PVCs which increased with increasing heart rate (B). Ventricular bigeminy was noted starting at a heart rate of 130 bpm (C). Ventricular couplets and triplets were noted around the time of peak exertion (D). All ventricular ectopy extinguished as the heart rate fell below 100 bpm (E)