ECG abnormalities that may be observed in arrhythmogenic right ventricular dysplasia

  Complete or incomplete right bundle branch block.

  Epsilon wave: a very infrequently observed late potential.

Remember: In patients with nodal (junctional) rhythm and post-QRS retrograde P waves, the prominent P waves in lead V1 and V2 may mimic Epsilon waves, at first glance.

  Negative T waves in right and mid precordials.

  Ventricular arryhthmias (usually as left bundle branch block (LBBB) morphology).



References

  Indian Pacing Electrophysiol J 2019 Feb 21. pii: S0972-6292(19)30034-8.

  J Am Coll Cardiol 1995;25:655

  Am J Cardiol 1995,75:411

  J Electrocardiol 1988;21:239




ECG 1. Epsilon wave in a patient with ARVD. To detect the epsilon wave, the ECG was recorded at a paper speed of
50mm/second and at a calibration of 20mm/mV by Fontaine modification.

Dr. Peter Kukla has donated this ECG to our website.

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ECG 2a. LBBB type ventricular tachycardia in a patient with ARVD. Limb leads, recorded at a speed of 50mm/second.

Dr. Peter Kukla has donated this ECG to our website.

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ECG 2b. LBBB type ventricular tachycardia in a patient with ARVD. Chest leads, recorded at a speed of 50mm/second.

Dr. Peter Kukla has donated this ECG to our website.

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EKG 3. Epsilon wave in ARVD.

Dr. Peter Kukla has donated this ECG to our website.

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ECG 4. The above ECG belongs to another patient with ARVD. There is no Epsilon wave in this ECG.

Dr. Kenji Yodogawa has donated this ECG to our website.

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ECG 5. ECG of a patient with arrhythmogenic right ventricular dysplasia (ARVD). No Epsilon wave is seen.
Negative T waves are seen in the right precordials (V1-V3).

Dr. Frank Marcus has donated this ECG to our website.

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ECG 6. Another patient with ARVD. No Epsilon wave is seen.
Negative T waves are seen in the right and mid- precordials (V1-V4).

Dr. Frank Marcus has donated this ECG to our website.




ECG 7. The above ECG belongs to a patient with ARVD. Arrows point to the Epsilon wave.

Dr. Alex Horby Christensen has donated this ECG to our website.




ECG 8. Above is the ECG of a 17 years-old girl with arrhythmogenic right ventricular dysplasia (ARVD).
Giant Epsilon waves are seen in leads C1 and C2 . Epsilon waves of lesser amplitude are also seen in limb leads.
The wide QRS complex on the left is an end-diastolic ventricular premature contraction.

Pediatric Cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.

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ECG 9a. Epsilon wave from a 63 years-old woman with ARVD.
ECHOcardiography showed a normal left ventricle with a dilated and severely hypokinetic right ventricle.
Her right ventricular wall was very thin.
The above ECG was recorded at a standard calibration of 10 mm/mV.

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ECG 9b. Epsilon wave from a 63 years-old woman with ARVD.
The above ECG and the ECG 9a belong to the same woman.
The above ECG was recorded at a calibration of 20 mm/mV to depict the Epsilon waves clearly.

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ECG 10. The ECG above belongs to a 6 years-old child. It was recorded just before permanent pacemaker implantation.
He had undergone Atrial Septal Defect (ASD) closure 2 years ago.
This ECG shows nodal rhythm with post-QRS retrograde P waves.
The fourth beat from the left is compatible with Posterior Fascicular Block.
This beat, may be a fascicular premature beat or an ECHO beat.
In patients with nodal (junctional) rhythm and post-QRS retrograde P waves, the prominent P waves in lead V1 and V2
may mimic Epsilon waves, at first glance.

Pediatric Cardiologist Prof. Dr. Tevfik Karagoz has donated the above ECG to our website.

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