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Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular

Tanyanan Tanawuttiwat1, Anneline S J M Te Riele1,2, Binu Philips3

  • 1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Journal of Cardiovascular Electrophysiology
|January 13, 2016
PubMed

Insights

Epsilon waves in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) indicate severe conduction delays and significant endocardial scarring. These ECG findings correlate with specific electrical activation patterns in the sub-tricuspid region.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Epsilon waves and right precordial lead abnormalities in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are hypothesized to stem from delayed right ventricular outflow tract activation.
  • Previous research has not directly linked cardiac electrical activation patterns to surface electrocardiogram (ECG) findings in ARVD/C patients.

Purpose of the Study:

  • To investigate the correlation between cardiac electrical activation patterns and surface ECG findings in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
  • To elucidate the electrophysiological basis of epsilon waves and other depolarization abnormalities in ARVD/C.

Main Methods:

  • Thirty ARVD/C patients underwent endocardial and epicardial electroanatomical activation mapping in sinus rhythm.
  • Twelve-lead ECGs were categorized into five patterns: normal QRS, terminal activation delay (TAD), incomplete right bundle branch block (IRBBB), epsilon wave, and complete right bundle branch block (CRBBB).
  • Local ventricular activation timing and scar extent were correlated with surface ECG findings.

Main Results:

  • Earliest right ventricular activation was consistently observed in the mid anteroseptal wall across all ECG patterns.
  • Total right ventricular activation times significantly increased from normal QRS to CRBBB, with epsilon wave patterns showing prolonged activation.
  • Patients with epsilon waves exhibited significantly higher median endocardial scar burden compared to those with CRBBB.

Conclusions:

  • Epsilon waves in ARVD/C are associated with substantial conduction delays and extensive endocardial scarring, alongside epicardial disease.
  • The timing of epsilon waves on the surface ECG corresponds to electrical activation originating from the sub-tricuspid region.
Abstract

Keywords:
arrhythmogenic right ventricularcatheter ablationdysplasia/cardiomyopathyepicardial mappingepsilon waveright bundle branch block

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