Detection of epsilon waves on 12-lead ECG in arrhythmogenic cardiomyopathy was associated with right ventricular outflow tract involvement (P=0.001) and sustained ventricular tachycardia (P=0.004).
Observational (n=86)
Does the presence of epsilon waves on 12-lead ECG correlate with structural abnormalities and clinical outcomes in patients with arrhythmogenic cardiomyopathy?
Epsilon waves in arrhythmogenic cardiomyopathy indicate significant right ventricular outflow tract involvement and an increased risk of sustained ventricular tachycardia, but not sudden cardiac death.
p-value: p=0.001
INTRODUCTION: Epsilon waves are hallmark features of arrhythmogenic cardiomyopathy (ACM) but information about their clinical significance is variable. We evaluated epsilon wave prevalence, characteristics, and their clinical significance in an ACM population. METHODS AND RESULTS: Eighty-six unselected patients fulfilling the 2010 Task Force criteria were enrolled. Seventy-six of them were carriers of desmosomal mutations. All subjects were serially evaluated with standard 12-lead ECG and 2-dimensional echocardiography. Epsilon waves were evaluated in all precordial and inferior leads. Novel parameters assessed included their duration and precordial/inferior lead extension. Twenty-five subjects (29%) had epsilon waves that were present in lead V3 and beyond in 9, and in the inferior leads in 7. Epsilon waves were associated with right ventricular outflow tract (RVOT) (P = 0.001) but not RV posterior wall (P = 0.21), RV apex (P = 0.30), or left ventricular (P = 0.94) wall motion abnormalities. Patients with epsilon waves had increased RVOT diameter (P < 0.0001). Extension of epsilon waves in lead V3 and beyond was associated with increased epsilon wave duration (P = 0.002) and RVOT diameter (P = 0.04). The duration of epsilon waves was positively correlated with RVOT diameter (r = 0.70, P = 0.0001). Epsilon waves were also associated with episodes of sustained ventricular tachycardia (P = 0.004) but not with heart failure (P = 0.41) or sudden cardiac death (P = 0.31). CONCLUSION: Detection of epsilon waves on 12-lead ECG reflects significant RVOT involvement, which was associated with episodes of sustained ventricular tachycardia but not sudden cardiac death.
Protonotarios et al. (Thu,) conducted a observational in Arrhythmogenic Cardiomyopathy (n=86). Epsilon waves on 12-lead ECG was evaluated on Right ventricular outflow tract (RVOT) wall motion abnormalities (p=0.001). Detection of epsilon waves on 12-lead ECG in arrhythmogenic cardiomyopathy was associated with right ventricular outflow tract involvement (P=0.001) and sustained ventricular tachycardia (P=0.004).