Arrhythmogenic Right Ventricular Dysplasia
Report:
Double sensitivity (1mV = 20mm)
Sinus rhythm 73/min
VEB
Right axis deviation (RAD) +110o
Right atrial abnormality (RAA)
Absolute small voltage (note the 20 mm/mV calibration)
Poor R wave progression
Nonspecific ST/T changes
Epsilon wave & V1/V6 duration c/c arrhythmogenic right ventricular dysplasia (ARVD)
Comment:
The patient presented originally with recurrent VT (Fig 88a) and eventually underwent extensive studies documenting her ARVD. The epsilon wave is the terminal “wrinkle” at the onset of the ST segment in lead V1; it corresponds to late small-amplitude potentials found at her EPS. It represents islands of late depolarisation often initiating reentry VT. The latter has a typical right ventricular morphology of LBBB (but with a slow S downslope in V1) and the (commonly found) LAD.
In ECGs taken at other times (not shown) there was T wave inversion in leads V1-3, also characteristic of ARVD. The trace shown has at least one other diagnostic criterion for ARVD: the QRS duration in V1 exceeds that of V6 by at least 0.06 sec33.
This patient also had an ICD which did not respond to the relatively slow VT shown below. It was programmed to fire at the rates over 160/min.
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