Unexplained Syncope With Abnormal ECG Findings in the Emergency Department: Don't Miss the Epsilon Wave!

Area of Science:

• Cardiology
• Genetics
• Emergency Medicine

Background:

• Arrhythmogenic cardiomyopathy (AC) is a genetic heart muscle disorder.
• It is a significant cause of sudden cardiac death in young adults.
• AC is often diagnosed in advanced stages, presenting in the emergency department (ED).

Purpose of the Study:

• To review the typical presentation of AC in the ED.
• To highlight key electrocardiographic (ECG) findings, including the epsilon wave.
• To define the role of emergency providers in managing suspected AC.

Main Methods:

• Case review of patients with suspected Arrhythmogenic Cardiomyopathy.
• Analysis of typical clinical presentations and emergency department encounters.
• Review of diagnostic criteria, focusing on electrocardiographic (ECG) findings.

Main Results:

• Common ED presentations include syncope, palpitations, and ventricular arrhythmias.
• The epsilon wave on ECG is a hallmark of advanced AC.
• Emergency providers often encounter advanced AC through syncope presentations.

Conclusions:

• Early recognition of AC in the ED is crucial despite diagnostic complexity.
• ECG interpretation, particularly the epsilon wave, aids in identifying potential AC.
• Defining the emergency provider's role can improve patient outcomes for this genetic cardiac disorder.