| Part one Prevalence of epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathyObjective To investigate the prevalence of epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).Methods The study included 32 patients (24 men and 8 women; aged 42.3±13.3 years) meeting the ESC diagnostic criteria for ARVD/C. The epsilon wave was detected using three different electrocardiography (ECG) recording methods, which were standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordial leads ECG (F-ECG). The epsilon wave was defined as wiggle wave, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment.Results The prevalence of epsilon wave with the use of three different methods of ECG recording were 37.50% (12/32), 37.50% (12/32) and 50.00% (16/32), respectively. There was no significant difference between each other (all P>0.05) The epsilon wave was not detected by other ECG recording methods but S-ECG in one case, R-ECG in three cases, and F-ECG in five cases. The detection rate of epsilon wave was 50.00% (16/32) using S-ECG combined with R-ECG (SR-ECG), while it was 56.25% (18/32) using S-ECG combined with F-ECG (SF- ECG), and it was 65.63% (21/32) when three methods were combined (SRF-ECG). The prevalence of epsilon wave using combined methods of ECG recording was significantly greater than that of S-ECG (SF-ECG 56.25% vs. S-ECG 37.5%, P<0.05, SRF-ECG 65.63% vs. S-ECG 37.5%, P<0.01). The patterns of the Epsilon waves detected by the S-ECG, R-ECG and F-ECG mostly presented with small spiked waves. In some circumstances, Epsilon waves were evident in some leads especially in leads V1 through V3, but presented with notches on the other leads on the corresponding phase.Conclusions Use of S-ECG in combination with F-ECG and R-ECG could increase the detection rate of epsilon wave, and different recording methods could complement each other. Part Two Characteristics of surface electrocardiogram in patients with arrhythmogenic right ventricular cardiomyopathyObjective The purpose of this study was to analysis the clinical and electrocardiogram characters of arrhythmogenic right ventricular cardiomyopathy (ARVC) and try to get more clues to diagnose ARVC.Methods We reevaluated ECG parameters in 32 patients with proven ARVC from 2000-2008 according to ESC Task Force criteria published in 1994.Results In a cohort of 32 patients (24 men and 8 women; aged 42.3±13.3 years). Eight patients (25.0%) had a history of syncope. The incidence of epsilon potential was 37.5%; prolonged QRS width in the right precordial leads (V1 +V2 +V3) / (V4 +V5 +V6)≥1. 2 was 46.9%; terminal activation delay (TAD)≥55ms was 53.1%; complete right bundle branch block was 9.3% and incomplete right bundle branch block was 3.1%. Fragmented QRS and abnormal Q wave was observed in 71.9% and 25.0% of ARVC patients, respectively. In the absence of bundle branch block, T wave inversion in V1-V3 was observed in 43.6% in this group. Ventricular tachycardia (VT) was documented in 28 cases, of them 25 were complete left ventricular bundle branch block. Echocardiography and right ventricular angiography had shown that most of affected areas were found in RV free wall and RV outflow tract, mainly manifested RV dilation, regional outpouchings. 23 patients received ablation, three-dimensional mapping disclosed the distribution of low-voltage regions which mainly located around tricuspid annulus and right ventricular outflow tract.Conclusions . ARVC was primarily affected young patients and the diagnosis was made mostly because of ventricular arrhythmia originating from RV. Electrocardiography parameters related to activation delay such as Epsilon wave, QRS duration in (V1 +V2 +V3) / (V4 +V5 +V6)≥1.2, TAD≥55ms and fragmented QRS complex, contribute significantly to the noninvasive diagnosis of ARVC. |
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