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Protonotarios A, Anastasakis A, Tsatsopoulou A, et al. Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy. J Cardiovasc Electrophysiol. 2015;26(11):1204-1210doi: 10.1111/jce.12755.
Protonotarios, A., Anastasakis, A., Tsatsopoulou, A., Antoniades, L., Prappa, E., Syrris, P., Tousoulis, D., McKENNA, W. J., & Protonotarios, N. (2015). Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy. Journal of cardiovascular electrophysiology, 26(11), 1204-1210. https://doi.org/10.1111/jce.12755
Protonotarios, Alexandros, et al. "Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy." Journal of cardiovascular electrophysiology vol. 26,11 (2015): 1204-1210. doi: https://doi.org/10.1111/jce.12755
Protonotarios A, Anastasakis A, Tsatsopoulou A, Antoniades L, Prappa E, Syrris P, Tousoulis D, McKENNA WJ, Protonotarios N. Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy. J Cardiovasc Electrophysiol. 2015 Nov;26(11):1204-1210. doi: 10.1111/jce.12755. Epub 2015 Sep 06. PMID: 26183028.
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J Cardiovasc Electrophysiol. 2015 Nov;26(11):1204-1210. doi: 10.1111/jce.12755. Epub 2015 Sep 06.

Clinical Significance of Epsilon Waves in Arrhythmogenic Cardiomyopathy.

Journal of cardiovascular electrophysiology

Alexandros Protonotarios, Aris Anastasakis, Adalena Tsatsopoulou, Loizos Antoniades, Efstathia Prappa, Petros Syrris, Dimitrios Tousoulis, William J McKENNA, Nikos Protonotarios

Affiliations

  1. Nikos Protonotarios Medical Centre, Naxos, Greece.
  2. 1st Department of Cardiology, University of Athens Medical School, Athens, Greece.
  3. Department of Cardiology, Nicosia General Hospital, Nicosia, Cyprus.
  4. 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
  5. Institute of Cardiovascular Science, University College London and The Heart Hospital, University College London Hospitals Trust, London, UK.

PMID: 26183028 DOI: 10.1111/jce.12755

Abstract

INTRODUCTION: Epsilon waves are hallmark features of arrhythmogenic cardiomyopathy (ACM) but information about their clinical significance is variable. We evaluated epsilon wave prevalence, characteristics, and their clinical significance in an ACM population.

METHODS AND RESULTS: Eighty-six unselected patients fulfilling the 2010 Task Force criteria were enrolled. Seventy-six of them were carriers of desmosomal mutations. All subjects were serially evaluated with standard 12-lead ECG and 2-dimensional echocardiography. Epsilon waves were evaluated in all precordial and inferior leads. Novel parameters assessed included their duration and precordial/inferior lead extension. Twenty-five subjects (29%) had epsilon waves that were present in lead V3 and beyond in 9, and in the inferior leads in 7. Epsilon waves were associated with right ventricular outflow tract (RVOT) (P = 0.001) but not RV posterior wall (P = 0.21), RV apex (P = 0.30), or left ventricular (P = 0.94) wall motion abnormalities. Patients with epsilon waves had increased RVOT diameter (P < 0.0001). Extension of epsilon waves in lead V3 and beyond was associated with increased epsilon wave duration (P = 0.002) and RVOT diameter (P = 0.04). The duration of epsilon waves was positively correlated with RVOT diameter (r = 0.70, P = 0.0001). Epsilon waves were also associated with episodes of sustained ventricular tachycardia (P = 0.004) but not with heart failure (P = 0.41) or sudden cardiac death (P = 0.31).

CONCLUSION: Detection of epsilon waves on 12-lead ECG reflects significant RVOT involvement, which was associated with episodes of sustained ventricular tachycardia but not sudden cardiac death.

© 2015 Wiley Periodicals, Inc.

Keywords: arrhythmogenic right ventricular cardiomyopathy; arrhythmogenic right ventricular dysplasia; epsilon waves; right bundle branch block; sudden cardiac death

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