Epsilon wave: A review of historical aspects

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Ventricular depolarization abnormalities, including the epsilon wave, fragmented QRS, and various right bundle branch blocks (RBBB), are associated with arrhythmogenic cardiomyopathy (AC).
• The epsilon wave is a major diagnostic criterion for AC, but its diagnostic value is limited due to its late-stage manifestation and low sensitivity.

Purpose of the Study:

• To provide an update on the nomenclature, disease associations, and electrocardiographic aspects of the epsilon wave.
• To clarify the diagnostic utility and limitations of the epsilon wave in the context of arrhythmogenic cardiomyopathy.

Main Methods:

• Literature review and synthesis of current knowledge on epsilon waves in cardiac conditions.
• Analysis of electrocardiographic criteria and their association with arrhythmogenic cardiomyopathy.

Main Results:

• The epsilon wave, while highly specific for AC, exhibits low sensitivity and is considered a late-stage marker.
• The epsilon wave can be present in other pathological conditions, necessitating careful interpretation.
• Fragmented QRS, terminal conduction delay, and RBBB patterns are part of the spectrum of ventricular depolarization abnormalities in AC.

Conclusions:

• The epsilon wave is a significant but not universally present indicator of arrhythmogenic cardiomyopathy.
• Understanding the nuances of epsilon wave interpretation, including its limitations and associations, is crucial for accurate AC diagnosis.