Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy According to Disease Severity A Need to Broaden Diagnostic Criteria

• Published in: Circulation (New York, N.Y.) Vol. 110; no. 12; pp. 1527 - 1534
• Main Authors: Nasir, Khurram, Bomma, Chandra, Tandri, Harikrishna, Roguin, Ariel, Dalal, Darshan, Prakasa, Kalpana, Tichnell, Crystal, James, Cynthia, Jspevak, Phillip, Marcus, Frank, Calkins, Hugh
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21.09.2004
• Subjects: Adult; Arrhythmogenic Right Ventricular Dysplasia - complications; Arrhythmogenic Right Ventricular Dysplasia - diagnosis; Arrhythmogenic Right Ventricular Dysplasia - physiopathology; Biological and medical sciences; Blood and lymphatic vessels; Bundle-Branch Block - complications; Bundle-Branch Block - physiopathology; Cardiology. Vascular system; Diseases of the lymphatic vessels; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Humans; Male; Medical sciences; Middle Aged; Prognosis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Arrhythmia; Cardiomyopathy; Arrhythmogenic right ventricular dysplasia; Heart disease; Electrocardiography; Cardiovascular disease; Diagnosis; Myocardial disease
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.0000142293.60725.18

Background— The purpose of this study was to systematically study diagnostic and prognostic electrocardiographic (ECG) characteristics of arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C). Methods and Results— The patient population included 50 patients with ARVD/C (27 males, 23 females; mean age 38±15 years). We also analyzed the ECG of 50 age- and gender-matched normal control subject and 28 consecutive patients who presented with right ventricular outflow tract (RVOT) tachycardia. Right bundle-branch block (RBBB) was present in 11 patients (22%). T-wave inversions in V 1 through V 3 were observed in 85% of ARVD/C patients in the absence of RBBB compared with none in RVOT and normal controls, respectively ( P <0.0001); epsilon waves were seen in 33%, and a QRS duration ≥110 ms in V 1 through V 3 was present in 64% of patients. Among those without RBBB, our newly proposed criterion of “prolonged S-wave upstroke in V 1 through V 3” ≥55 ms was the most prevalent ECG feature (95%) and correlated with disease severity and induction of VT on electrophysiological study. This feature also best distinguished ARVD/C (diffuse and localized) from RVOT. Conclusions— A prolonged S-wave upstroke in V 1 through V 3 is the most frequent ECG finding in ARVD/C and should be considered as a diagnostic ECG marker.