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[Prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy]
Jing Wang1, Bing Yang, Ming-long Chen
1Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Insights
The Epsilon wave, a marker for arrhythmogenic right ventricular cardiomyopathy (ARVC), is best detected using a combination of electrocardiography (ECG) methods. Combining standard 12-lead ECG, right precordial leads ECG, and Fontaine bipolar precordial leads ECG significantly improves detection rates in ARVC patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Context:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic heart disease.
- Early detection of ARVC is crucial for preventing sudden cardiac death.
- The Epsilon wave is a subtle ECG finding associated with ARVC.
Purpose:
- To evaluate the prevalence of the Epsilon wave in ARVC patients.
- To compare the detection rates of Epsilon waves using standard 12-lead ECG (S-ECG), right precordial leads ECG (R-ECG), and Fontaine bipolar precordial leads ECG (F-ECG).
- To determine the optimal ECG method for Epsilon wave detection in ARVC.
Summary:
- The study analyzed 32 ARVC patients using S-ECG, R-ECG, and F-ECG.
- Epsilon wave detection rates were 37.5% (S-ECG), 37.5% (R-ECG), and 50.0% (F-ECG).
- Combined methods (SF-ECG and SRF-ECG) significantly increased detection rates to 56.3% and 65.6%, respectively.
Impact:
- Combined ECG approaches enhance the diagnostic yield for Epsilon waves in ARVC.
- Improved detection of Epsilon waves can aid in earlier ARVC diagnosis and risk stratification.
- This study highlights the value of multi-lead ECG strategies in identifying subtle cardiac abnormalities.
Objective:
To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).
Methods:
The epsilon wave was detected in 32 patients [24 men, mean age (42.3 +/- 13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: 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 wiggler, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment.
Results:
Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar (P > 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P < 0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves.
Conclusion:
Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.
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