Syncopal Episode in an Otherwise Healthy 15-Year-Old Boy

A 15-year-old boy presents for evaluation after a syncopal episode while playing football. He denies any current headache, chest pain, or shortness of breath. He admits to feeling heart palpitations before losing consciousness.

On further questioning, he admits to episodes of palpitations over the past 6 months, though no prior history of syncope. He has no other past medical or surgical history. He takes no prescription or over-the-counter medications. He has no known food or drug allergies and denies alcohol and recreational drug use. Pertinent family history: his father died at age 30 years of sudden cardiac death.

The patient’s vital signs were all within normal limits; heart rate, 64 beats/min. Physical examination was normal, no heart murmurs were heard.

ECG tracing shown in Figure, above right.

1.  What is your interpretation of this ECG?

2.  What is the diagnosis?

3.  What is the treatment?

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