Electrocardiographic features of arrhythmogenic right ventricular dysplasia/cardiomyopathy according to disease severity: A need to broaden diagnostic criteria

Khurram Nasir, Chandra Bomma, Harikrishna Tandri, Ariel Roguin, Darshan Dalal, Kalpana Prakasa, Crystal Tichnell, Cynthia James, Phillip Jspevak, Frank Marcus, Hugh Calkins

Research output: Contribution to journalArticlepeer-review

Abstract

Background - The purpose of this study was to systematically study diagnostic and prognostic electrocardiographic (ECG) characteristics of arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C). Methods and Results - The patient population included 50 patients with ARVD/C (27 males, 23 females; mean age 38±15 years). We also analyzed the ECG of 50 age- and gender-matched normal control subject and 28 consecutive patients who presented with right ventricular outflow tract (RVOT) tachycardia. Right bundle-branch block (RBBB) was present in 11 patients (22%). T-wave inversions in V 1 through V3 were observed in 85% of ARVD/C patients in the absence of RBBB compared with none in RVOT and normal controls, respectively (P<0.0001); epsilon waves were seen in 33%, and a QRS duration ≥110 ms in V1 through V3 was present in 64% of patients. Among those without RBBB, our newly proposed criterion of "prolonged S-wave upstroke in V1 through V3" ≥55 ms was the most prevalent ECG feature (95%) and correlated with disease severity and induction of VT on electrophysiological study. This feature also best distinguished ARVD/C (diffuse and localized) from RVOT. Conclusions - A prolonged S-wave upstroke in V 1 through V3 is the most frequent ECG finding in ARVD/C and should be considered as a diagnostic ECG marker.

Original languageEnglish (US)
Pages (from-to)1527-1534
Number of pages8
JournalCirculation
Volume110
Issue number12
DOIs
StatePublished - Sep 21 2004

Keywords

  • Cardiomyopathy
  • Diagnosis
  • Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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