Arrhythmogenic right ventricular dysplasia ECG

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In order to make the diagnosis of ARVD, a number of clinical tests are employed, including the electrocardiogram (EKG), echocardiography, right ventricular angiography, and cardiac MRI.

ECG Findings

90% of individuals with ARVD have some EKG abnormality. The most common EKG abnormality seen in ARVD is T wave inversion in leads V₁ to V₃. However, this is a non-specific finding, and may be considered a normal variant in right bundle branch block (RBBB), women, and children under 12 years old.

RBBB itself is seen frequently in individuals with ARVD. This may be due to delayed activation of the right ventricle, rather than any intrinsic abnormality in the right bundle branch.

EKG lead demonstrating the epsilon wave The epsilon wave

The epsilon wave (red triangle), seen in ARVD.

The epsilon wave is found in about 50% of those with ARVD. This is described as a terminal notch in the QRS complex. It is due to slowed intraventricular conduction. The epsilon wave may be seen on a surface EKG; however, it is more commonly seen on signal averaged EKGs.

Ventricular ectopy seen on a surface EKG in the setting of ARVD is typically of left bundle branch block (LBBB) morphology, with a QRS axis of -90 to +110 degrees. The origin of the ectopic beats is usually from one of the three regions of fatty degeneration (the "triangle of dysplasia"): the RV outflow tract, the RV inflow tract, and the RV apex.

Signal averaged ECG

Signal averaged ECG (SAECG) is used to detect late potentials and epsilon waves in individuals with ARVD.

Right Ventricular Outflow Tract Ventricular Tachycardia=

The presence of right ventricular outflow tract ventricular tachycardia should prompt suspicion of AVRD.