Abstract 16060: Electrocardiographic Analysis of Arrhythmogenic Right Ventricular Cardiomyopathy: Cardiovascular Events and the Epsilon Wave
Background: The abnormal ECG parameters, such as epsilon wave are specific observations in diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, little is known in the relationship between cardiovascular events and ECG observation during follow-up in ARVC.
Methods: 91 patients with ARVC (mean age of 47 ± 14 and 73 males) were enrolled in this study. We examined ECG characteristics recorded at the beginning of follow-up. The epsilon wave distribution (ε wave distribution) was defined as the number of leads showing the epsilon wave among 12 lead ECG. Right ventricular ejection fraction (RVEF) was analyzed by the contrast-enhanced CT, MRI, or myocardial scintigraphy. The primary endpoint was cardiovascular mortality and secondary endpoint was hospitalization due to heart failure (HF).
Results: During the 8.6±6.7 yrs follow-up, cardiac death was observed in 11 patients (fatal group; 12%). The ε wave in any of 12 leads was observed significantly higher in the fatal group than the survival group (64% vs 24%, p=0.01). Furthermore, the fatal group had significantly wider ε wave distribution compared with the survival group (3.8 of 12 leads vs. 1.6 of 12 leads, p=0.045) and also the wider ε wave distribution correlated to a lower RVEF (p=0.04). Especially patients with the ε wave in the aVR lead had significantly higher cardiac mortality (33% vs. 15%, p=0.03), hospitalization due to HF (47% vs 15%, p=0.006) and lower RVEF (21% vs. 30%, p=0.01) compared with those without the ε wave in the aVR lead. There was no significant difference in the events of ventricular tachyarrhythmias in patients with or without ε wave in aVR.
Conclusion: In ARVC, the wide distribution of ε wave and the ε wave in the aVR lead correlated to severe right ventricle impairment and cardiovascular mortality.
- © 2013 by American Heart Association, Inc.