title: Electrocardiographic features of arrhythmogenic right ventricular dysplasia/cardiomyopathy according to disease severity: a need to broaden diagnostic criteria.
abstract: BACKGROUND
  The purpose of this study was to systematically study diagnostic and prognostic electrocardiographic (ECG) characteristics of arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C).
  
  
  RESULTS
  The patient population included 50 patients with ARVD/C (27 males, 23 females; mean age 38+/-15 years). We also analyzed the ECG of 50 age- and gender-matched normal control subject and 28 consecutive patients who presented with right ventricular outflow tract (RVOT) tachycardia. Right bundle-branch block (RBBB) was present in 11 patients (22%). T-wave inversions in V1 through V3 were observed in 85% of ARVD/C patients in the absence of RBBB compared with none in RVOT and normal controls, respectively (P<0.0001); epsilon waves were seen in 33%, and a QRS duration > or =110 ms in V1 through V3 was present in 64% of patients. Among those without RBBB, our newly proposed criterion of "prolonged S-wave upstroke in V1 through V3" > or =55 ms was the most prevalent ECG feature (95%) and correlated with disease severity and induction of VT on electrophysiological study. This feature also best distinguished ARVD/C (diffuse and localized) from RVOT.
  
  
  CONCLUSIONS
  A prolonged S-wave upstroke in V1 through V3 is the most frequent ECG finding in ARVD/C and should be considered as a diagnostic ECG marker.
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Md, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Chandra
authors.initials: C
authors.lastname: Bomma
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Kalpana
authors.initials: K
authors.lastname: Prakasa
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.forename: Cynthia
authors.initials: C
authors.lastname: James
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Spevak
authors.forename: Phillip
authors.initials: P
authors.lastname: Jspevak
authors.forename: Frank
authors.initials: F
authors.lastname: Marcus
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000150:complications / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis