Epsilon Wave

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

Epsilon Wave

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

Further Reading

Author Credits

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]
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