Definition
- The epsilon wave is a small positive deflection (‘blip’) buried in the end of the QRS complex.
- It is the characteristic finding in arrhythmogenic right ventricular dysplasia (ARVD).
Examples of Epsilon Waves
Reproduced from ECGpedia.org. Click image for link.
Image reproduced from Wikimedia Commons. Click for link.
Image reproduced from heartpearls.com. Click for link.
Image reproduced from heartpearls.com. Click for link.
Image reproduced from Perez Diez & Brugada. Click for source.
Arrhythmogenic Right Ventricular Dysplasia
The following 12-lead ECG is a typical example of ARVD.
Image reproduced from heartpearls.com. Click for link.
The ECG changes in ARVD include:
- Epsilon wave (most specific finding, seen in 30% of patients)
- T wave inversions in V1-3 (85% of patients)
- Prolonged S-wave upstroke of 55ms in V1-3 (95% of patients)
- Localised QRS widening of 110ms in V1-3
- Paroxysmal episodes of ventricular tachycardia with a LBBB morphology
Prolonged S-wave upstroke in ARVD
Image adapted from Corrada et al. Click for link.
VT with LBBB morphology due to ARVD
Related Topics
- Arrhythmogenic right ventricular dysplasia
- Right ventricular outflow tract VT
- ECG Exigency 008 — Sudden Syncope on the Soccer Field
Further Reading
- ECG BASICS — Waves, Intervals, Segments and Clinical Interpretation
- ECG CLINICAL CASES — Your favourite ECG’s placed in clinical context with a challenging Q&A approach
- ECG and Cardiology Eponymous Syndromes — Cheats guide to eponymous emancipation
- ECG Exam Template — a framework for the FACEM part 2 exam.
- ECG Reference Sites on the WEB — the best of the rest
Author Credits
- Words - Ed Burns
- Pictures - Ed Burns
- Web Editing - Mike Cadogan, Ed Burns
References
- Corrado D, Biffi A, Basso C, Pelliccia A, Thiene G. Twelve-lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med 2009; 43 :669-676. [PMID: 19734501] [Full text]
- Perez Diez D, Brugada J. Diagnosis and Management of Arrhythmogenic Right Ventricular Dysplasia: An article from the E-Journal of the ESC Council for Cardiology Practice, European Society of Cardiology 2008. [Reference]
About Edward Burns
