gms | German Medical Science

Question: ECG parameters represent major and minor criteria in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). Data regarding the clinical validation of these criteria are limited. The aim of this study was to specify and to define ECG characteristics in ARVC patients.

Method Used: In 20 ARVC patients (14 males, mean age 47 ±17 years), standard surface ECG parameters were compared with those of 20 healthy subjects (case-control design). The diagnosis of ARVC was made according to the guidelines of the international Task Force for the Diagnosis of ARVC (1985). The following ECG parameters were analyzed: presence of epsilon wave, duration of QRS complex and inverted T waves in absence of right bundle branch block. In addition the QRS complex duration ratio of the right precordial to the left precordial leads ((V1+V2+V3) / (V4+V5+V6)) were calculated.

Results: In ARVC pts., mean QRS duration in right precordial leads was: V1 - 94 ms ±11, V2 - 102 ms ±11 and 99 ms ±9. The values in controls were shorter, however the difference did not reach statistically significance. Only 15% of the ARVC patients showed a prolongation of QRS complex duration >110 ms in V1 – V3. 9 ARVC pts. (45 %) showed inverted T - waves in V2 - V3. 5 (25 %) had epsilon waves. In the control group no T wave abnormalities or epsilon waves were detected. Mean QRS complex ratio in the ARVC group was 1,24 (range: 1,03 – 1,48) and 1,19 (range: 0,85 – 1,57) in the controls, respectively (P ≤ 0,005).

Conclusion: ARVC pts. frequently have ECG abnormalities presumably reflecting right ventricular pathology. However, prolongation of right precordial QRS duration (V1-V3) is often moderate. An increased ratio has a sensitivity of 50% (specificity 65%). Diagnostic sensitivity increases when in addition right precordial T – wave (V2-V3) inversion is considered (sensitivity 70%, specificity 65%). Epsilon waves are a low sensitive (25%) for ARVC but a highly specific (100%).