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Heart failure and cardiomyopathy
Dynamic electrocardiographic changes in patients with arrhythmogenic right ventricular cardiomyopathy
  1. Giovanni Quarta1,2,
  2. Deirdre Ward1,
  3. María T Tomé Esteban1,
  4. Antonios Pantazis1,
  5. Perry M Elliott1,
  6. Massimo Volpe2,3,
  7. Camillo Autore2,
  8. William J McKenna1
  1. 1The Heart Hospital, University College London Hospitals Trust, London, UK
  2. 2Department of Cardiology, S. Andrea Hospital, University ‘La Sapienza’, Rome, Italy
  3. 3IRCCS Neuromed, Pozzilli, Italy
  1. Correspondence to Professor William J McKenna, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16–18 Westmoreland Street, London W1G 8PH, UK; william.mckenna{at}uclh.org

Abstract

Background and objectives Electrocardiographic (ECG) abnormalities of depolarisation and repolarisation contribute to the diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC). The development of diagnostic ECG features were investigated in a genotyped cohort with ARVC to provide more sensitive markers of early disease.

Methods T-wave inversion (TWI) in right precordial leads, epsilon waves, localised QRS prolongation greater than 110 ms in V1–V3 and QRS dispersion greater than 40 ms were analysed from 317 ECG from 68 genotyped patients (34 with disease-causing mutations) during follow-up of 34±28 months.

Results 16 patients (23%) had changes during follow-up, with the appearance of new ECG abnormalities in seven (10%) and dynamic changes in nine (13%). Four developed new and persistent TWI and eight had dynamic TWI in right precordial leads. Three developed new and another three had dynamic epsilon waves. No changes were observed in 10 with and 58 patients without localised QRS prolongation and in six patients with and 61 without QRS dispersion greater than 40 ms. An additional patient with QRS dispersion at baseline had normal depolarisation dispersion during follow-up. None of the nine ARVC patients with dynamic ECG changes had major structural or functional right ventricular abnormalities, suggesting an early stage of the disease.

Conclusions New or dynamic ECG changes were observed in 23%. This underscores the importance of serial ECG in the diagnosis of individuals at risk of ARVC, in whom potentially lethal arrhythmia may develop before major abnormalities are detectable with conventional imaging.

  • Arrhythmias
  • arrhythmic right ventricular dysplasia
  • arrhythmogenic right ventricular cardiomyopathy
  • electrocardiogram
  • electrocardiography

https://doi.org/10.1136/hrt.2009.182949

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    Footnotes

    • Funding GQ is supported by a PhD fellowship from the University ‘La Sapienza’ of Rome and by a European Society of Cardiology research grant; DW is supported by a British Heart Foundation fellowship grant FS/04/025; WJM is supported by EU 5th Framework Program Research and Technology Development grant QLG1-CT-2000-01091 and by British Heart Foundation programme grant RG/04/010. This work was undertaken at University College London Hospital/University College London, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the Ethics Committee, University College London.

    • Provenance and peer review Not commissioned; externally peer reviewed.