A Case of Atrial Fibrillation and Rapid Ventricular Response in a 22-Year-Old Athlete With Sickle Cell Trait

TL;DR

A young athlete with sickle cell trait experienced a rare case of atrial fibrillation, highlighting the need for awareness and proper management in similar cases.

Contribution

This case report documents a rare occurrence of atrial fibrillation in a young athlete with sickle cell trait.

Findings

A 22-year-old athlete with sickle cell trait presented with atrial fibrillation and rapid ventricular response.

Treatment included rate control, cardioversion, and anticoagulation, followed by referral for catheter ablation.

Preventive measures like hydration and education are recommended for athletes with sickle cell trait.

Abstract

Sickle cell trait (SCT) is generally regarded as a benign carrier state of sickle cell disease (SCD); however, emerging evidence indicates that it may be associated with adverse cardiovascular outcomes, including atrial fibrillation (AF). AF is uncommon among young, otherwise healthy athletes, and its occurrence in individuals with SCT is not extensively documented. We present a case involving a 22-year-old male collegiate football player with a history of SCT who presented with palpitations initiated during practice. Upon arrival, he was hemodynamically stable; nonetheless, his initial electrocardiogram (ECG) revealed atrial fibrillation with rapid ventricular response (AF RVR). Laboratory investigations were unremarkable, including a normal troponin level. The patient was administered intravenous (IV) diltiazem for rate control, and synchronized cardioversion was successfully performed to restore sinus rhythm. Short-term anticoagulation therapy with apixaban was prescribed, along with flecainide on an as-needed basis for rhythm management. The patient was subsequently referred for outpatient catheter ablation and placed on a three-month restriction from contact sports. This case underscores a rare presentation of AF RVR in a young athlete with SCT. Exertional stress may contribute to arrhythmogenesis through mechanisms such as vaso-occlusion, hypoxia, acidosis, and dehydration. Current guidelines recommend rate control, cardioversion when clinically indicated, and short-term anticoagulation in cases of new-onset AF. Catheter ablation presents a potential definitive therapeutic option for young, symptomatic individuals. Preventive measures for athletes with SCT should include adequate hydration, heat acclimatization, and education of players and coaching staff. This case highlights the importance of heightened awareness, adherence to guideline-based management, and the necessity for further research into the association between SCT and AF in young athletes.

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