- 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
Arrhythmogenic Right Ventricular Dysplasia
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
The following 12-lead ECG is a typical example of ARVD.
Prolonged S-wave upstroke in ARVD
VT with LBBB morphology due to ARVD
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- 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]