Dear colleagues, recently a 14 year old (175cm 64Kg) professional soccer player presented with the following ECG changes at rest (see attached file, note QRS, and QTc duration). A exercise test revealed the following ST-segment changes in V1/V2; test was performed until 280 Watts (note QRs duration was 110ms at times, changes in V2 started with 70 Watts)

The athlete had no symptoms during the test, nor had he any history of fainting, dizziness or palpitation, no tachycardia during rest. There's no family history of palpitation or sudden cardiac death.

3-lead Holter-ECG showed no ventricular or supraventricular tachcardia, no ectopic beats, no QTc duration above 460ms, no AV-blocks. 12-lead Holter ECG has not yet been conducted.

In the echocardiography performed here we could not normal diameters with normal LV function, normal RV-wall movement, no valvular irregularities, RVOT was 14mm, showing no gradient. RV Apex showed thin wall, and minimal pouches (see attached files).

Cardiac MRI showed no major ARVD criterion.

Coronary CT showed superficial mycardial bridge-ing of the rather large DG1 of 4mm length (see attached VR reconstructions, rather poor quality due to radiation reduction protocol for the athlete is very young).

Since location of bridge-ing and ECG changes are suggestive a perfusion MRI will be performed in the near future (DG is rather large, bridge-ing superficial - rather unlikely to show lack of perfusion)

I thought ist tempting to share the case, since it is rather difficult and differential diagnosis are narrowed down...I would like to hear your thoughts and hints on this case (I recommended another MRI with 16 to 18 years - for I think it could be an ARVD developing, not yet showing criteria).

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