Arrhythmogenic right ventricular dysplasia ECG
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Differentiating Arrhythmogenic right ventricular dysplasia from other Diseases |
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Arrhythmogenic right ventricular dysplasia ECG On the Web |
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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).
ECG Findings
90% of individuals with ARVD have some EKG abnormality.
T Wave Inversion Beyond V1
The most common EKG abnormality seen in ARVD is T wave inversion in leads V1 to V3. The presence of T wave inversion beyond V1 in a young athlete should always raise a suspicion of ARVD. 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.
Right Bundle Branch Block
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.
 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.
Electrocardiographic characteristics include the following:
- Atrioventricular dissociation similar to all patients with VT
- Heart rate > 100 beats per minute
- QRS duration > 120 milliseconds
- Left bundle branch block pattern or morphology with negative deflection in V1 and V2
- A rightward and inferior axis deviation (approximately +90 degrees)
