Abstract 3322: Importance of ECG Presentation of Newly Identified ARVD Probands: Findings from the North American ARVD Registry
Background. Diagnosis of ARVD is based on combination of Task Force criteria combining clinical, pathology, imaging, and ECG findings, and family history of cardiac events. The aim of this study was to determine how often ECG findings contribute to the diagnosis in newly diagnosed ARVD patients.
Methods. We enroll newly identified patients suspected of having ARVD in the North American ARVD Registry. Noninvasive testing including: ECG, SAECG, Holter, ECHO, MRI and invasive testing: RV Angio, RV Biopsy were performed in enrolled probands and centrally evaluated by expert core labs. ARVD Task Force criteria were being used to determine diagnosis of ARVD.
Results. The data included analysis of 82 probands (mean age 34±16 years; 32 [39%] females) of which 74 were classified as affected by Task Force criteria. Repolarization abnormalities consisting of inverted T waves in V2 and V3 in absence of right bundle block were found in 49 (60%) of probands and negative T waves in II, III, avF in 46 (56%). Epsilon waves were observed in 5 (6%) patients. SAECG showed late potentials in 37 (45%) patients. Sustained & nonsustained VT of LBBB morphology, documented by ECG, Holter or exercise testing were found in 57 (70%) of patients. QRS in V1-V3 was 107+/−29 ms vs. 101+/−27 ms in V4-V6 (p=0.002), however only 6% of affected individuals had difference in QRS duration of at least 30 ms and 20% of at least 20 ms between right and left precordial leads. Frequent ventricular extrasystoles (>1000/24 hrs) in Holter monitoring were present in 58% patients. When combining the above ECG, SAECG, and Holter findings, at least one of the abnormalities were present in 60 (89%) of 67 patients with major criteria and in 75 of 75 (100%) patients with minor criteria. There were no differences in frequency of the above abnormalities in males vs. females: 90% of men and 94% of women presented with ECG-based minor criteria.
Conclusions. ECG abnormalities contribute to diagnosis of ARVD in the majority of newly diagnosed patients. In contrary to previously reported series with more advanced ARVD, epsilon waves and localized QRS prolongation are observed infrequently in newly diagnosed ARVD patients. There are no gender differences in contribution of ECG parameters to clinical diagnosis of ARVD.