The Electrocardiographic Features And Clinical Observation In 36 Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Objective To investigate the Electrocardiographic characteristics and clinical manifestation of patients with arrhythmogenic right ventricular cardiomyopathy(ARVC).Methods 36 patients with ARVC were involved in this study according to the diagnosis criteria published by European Society of Cardiology.The clinical data including surface ECG,cardiac echo and electrophysiology study was investigated retrospectively.To control with the patients with ARVC,the ECG of 36 age-and gender-matched normal subjects and 26 consecutive patients with idiopathic right ventricular out-flow tract(RVOT)tachycardia were analysed.Results In a cohort of 36 patients(26 males,72%),the hospitalization and the initial presentation age was 11～65(37±13)and 5～62(32±14)years respectively.The palpitation and chest distress was present in 33 patients(92%),syncope in 11 patients(31%),and family history of sudden cardiac death in 2 patients(6%).The ECG study found that Epsilon waves were seen in 10 patients(28%),a QRS duration≥110 ms in right precordial leads(V₁～V₃)in 29 patients(81%).In 29 patients without RBBB,T-wave inversions and S-wave upstroke≥55ms in right precordial leads was found in 16(55%)and 18(62%)patients respectively,QRSd₁/QRSd₂(QRSd₁=the mean value of QRS durations in V₁～V₃,QRSd₂=the mean value of QRS durations in V₄～V₆)≥1.2 in 17 patients(47%),parietal intraventricular block in 24 patients(67%),QRS dispertion≥40ms and QT dispertion≥65ms was found in 15(52%)and 14(48%)patients respectively.Sustained or non-sustained ventricular tachycardia was recorded in 27(75%)patients.The cardiac Echo found ventricular aneurysm in 29 patients.25 patients underwent electrophysiological study;sustained ventricular tachycardia originating from the right ventricle was induced in 20 patients,only ablated by radiofrequency catheter at first procedure in 11 patients.Conclusions ARVC is an important reason of syncope,ventricular arrhythmias and right ventricular wall motion abnormalities in young man patients.The main characteristics in ECG include Epsilon waves,a QRS duration≥110 ms and T-wave inversions in right precordial leads, ventricular arrhythmia originating from right ventricle.Our findings suggest that QRSd₁/QRSd₂≥1.2,parietal intraventricular block and S-wave upstroke≥55ms in right precordial leads are helpful for diagnosis. The successful rate of ventricular tachycardia ablation in ARVC is relatively low by our experience.