Letters Regarding Article by Nasir et al, “Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy According to Disease Severity: A Need to Broaden Diagnostic Criteria”
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To the Editor:
We read with interest the article by Nasir et al1 that emphasizes the role of 12-lead ECG in the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). The authors examined the ECG parameters in 50 affected patients, finding that almost all presented abnormal features and proposed as a new diagnostic ECG marker of ARVC a prolonged S-wave upstroke in V1 through V3. However, in a series of 132 patients belonging to 37 families with ARVC/D, we found an abnormal ECG in only 47% of cases, even though among 19 probands who died suddenly, the test was within normal limits only once.2 Although these data are in accordance with those of Nasir et al, confirming that the severity of the disease correlates well with the ECG features, the statement that the 12-lead ECG is almost always abnormal can be misleading for the reader. The different prevalence of abnormal 12-lead ECG features of ARVC/D in our series versus that of Nasir et al is clearly the result of different patient selection. In our paper, selection was made on the basis of familiarity. Therefore, subjects with different extents of the disease were examined, and we found that the majority of them (64%) presented a mild form of the disease in terms of …