Long-RP Tachycardia in a Professional Cyclist: From Smartwatch to Ablation.

BACKGROUND

Long RP tachycardias share similar clinical presentations and challenging electrocardiographic features which frequently lead to diagnostic uncertainty. When unrecognized or misdiagnosed, the incessant behavior may lead to tachycardiomyopathy.

CASE SUMMARY: A 28-year-old asymptomatic professional cyclist presented after his Apple Watch repeatedly reported sustained elevated resting heart rate. Physical examination, laboratory results, imaging, and echocardiography were normal. Electrocardiogram showed narrow QRS tachycardia with negative P waves in inferior leads. Electrophysiological study excluded accessory pathways, localizing an ectopic atrial substrate at the posteroseptal tricuspid annulus. Radiofrequency ablation successfully eliminated the focal atrial tachycardia, restoring sinus rhythm. The Apple Watch confirmed stable heart rate normalization postprocedure and at follow-up.

DISCUSSION: We emphasize the role of wearable devices in early arrhythmia detection and the diagnostic challenges posed by long RP tachycardias.

TAKE-HOME MESSAGE: Smartwatches can fasten arrhythmias detection and management in asymptomatic athletes, and electrophysiological study remains essential for definitive supraventricular arrhythmias diagnosis.