The electrocardiogram in non-ischaemic-dilated cardiomyopathy

Figures

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  Figure 1. ECG findings of two DCM patients with LGE on CMR. ECG performed in 21-year-old woman shows low QRS voltages in V4–V6, LPFB, with AQRS ≈ + 120° and a premature ventricular beat with RBBB morphology and right axis deviation suggesting an origin in the LV lateral wall (A). On CMR, LGE involves the sub-epicardial lateral wall (B and C, white arrows). A 41-year-old man with a history of ventricular arrhythmias and ventricular dysfunction shows on ECG pathological lateral q waves (D, blue boxes), tall R wave in V1 (red box), and anterior T wave inversion (asterisks); his CMR reveals biventricular dilation and a stria LGE pattern with sub-epicardial distribution, mainly involving the LV lateral wall (E and F, white arrows). CMR, cardiac magnetic resonance; DCM, dilated cardiomyopathy; LGE, late gadolinium enhancement; LPFB, left posterior fascicular block; LV, left ventricular; RBBB, right bundle branch block.

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  Figure 2. ECG findings of DCM patients with arrhythmic genotypes. First ECG evidence of asymptomatic slow atrial fibrillation in 48 years-old female with a familiar history of SCD carrying likely pathogenic mutation in LMNA gene (A). Basal ECG of a 33 years-old man with a missense mutation in LMNA gene (p.Arg190Trp) displays signs of septal remodelling, such as pathological Q waves in leads V1–V4, poor R-wave progression (R wave <3 mm) in leads V1–V3 and QRS fragmentation. Extremely low QRS voltages in precordial leads, diffuse flat T waves, premature ventricular beats with LBBB, and inferior axis morphology are also present (B). A 51-year-old man with FLNC mutation and familiar history of DCM shows on ECG negative TWI in infero-lateral leads (C). ECG performed in 61-year-old man with a PLN p.Arg14del mutation. The ECG shows very low QRS voltages in limb leads, flat T waves, and poor R wave progression in precordial leads (D). DCM, dilated cardiomyopathy; FLNC, filamin C; LBBB, left bundle branch block; LMNA, lamin A/C; LV, left ventricular; PLN, phospholamban; SCD, sudden cardiac death; TWI, T wave inversion.