Key result
T-wave inversion in V1-V3 yields a ~10-fold higher odds of identifying ARVC versus outflow tract arrhythmias.
Why the study?
Differentiating arrhythmogenic right ventricular cardiomyopathy from idiopathic outflow tract ventricular arrhythmias remains challenging due to overlapping electrocardiographic features and limited accessibility of advanced imaging.
Do electrocardiographic parameters accurately differentiate arrhythmogenic right ventricular cardiomyopathy from idiopathic outflow tract ventricular arrhythmias in adult patients?
Meta-Analysis (n=723)
Do electrocardiographic parameters accurately differentiate arrhythmogenic right ventricular cardiomyopathy from idiopathic outflow tract ventricular arrhythmias in adult patients?
Answers are grounded in this paper and cite their sources.
ECG parameters, particularly depolarization indices, offer high specificity for differentiating ARVC from benign outflow tract arrhythmias, supporting their use as accessible rule-in diagnostic tools.
Background Differentiating arrhythmogenic right ventricular cardiomyopathy (ARVC) from idiopathic outflow tract ventricular arrhythmias (OT VA) remains a challenge due to overlapping electrocardiographic (ECG) features. However, their pathophysiology and prognosis differ. Given the limited accessibility of advanced imaging, ECG parameters could facilitate early diagnosis. This review and meta‐analysis evaluate the diagnostic accuracy of ECG parameters in distinguishing ARVC from OT VA. Methods A systematic database search was conducted from inception to March 2025. Observational studies assessing ECG markers for differentiating ARVC from OT VA in adults were included. Diagnostic accuracy metrics (sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve [AUC]) were synthesized using a bivariate random‐effects model. Risk of bias was assessed using the QUADAS‐2 tool. Results Ten studies enrolling 723 patients were included. T‐wave inversion in V1–V3 was the most commonly assessed parameter, with a pooled sensitivity of 0.55 and specificity of 0.88 (AUC = 0.798). Epsilon waves demonstrated low sensitivity (0.12) but high specificity (0.98). Among depolarization‐based parameters, QRS duration in V1–V3 (AUC = 0.832) and the ratio of QRS duration in precordial leads (AUC = 0.938) demonstrated strong diagnostic performance. S‐wave upstroke and terminal activation delay also showed high specificity (0.95) but moderate sensitivity. Conclusion Several ECG parameters, particularly depolarization‐based parameters, exhibit high specificity and moderate sensitivity in differentiating ARVC from OT VA. These findings support the use of ECG as a reliable and accessible diagnostic tool, particularly in settings without advanced imaging. A multi‐marker ECG approach may enhance early recognition of patients with suspected ARVC.
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Maharani et al. (2026) conducted a meta-analysis in Arrhythmogenic right ventricular cardiomyopathy (ARVC) vs idiopathic outflow tract ventricular arrhythmias (OT VA) (n=723). Electrocardiographic (ECG) parameters (e.g., T-wave inversion, QRS duration) vs. Idiopathic outflow tract ventricular arrhythmias (OT VA) was evaluated on Diagnostic accuracy of T-wave inversion in V1-V3 for differentiating ARVC from OT VA (DOR 9.54, 95% CI 3.41-26.66). T-wave inversion in V1-V3 demonstrated a pooled diagnostic odds ratio of 9.54, exhibiting high specificity and moderate sensitivity in differentiating ARVC from idiopathic outflow tract ventricular arrhythmias.
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