title: Electrocardiographic features of arrhythmogenic right ventricular dysplasia.
abstract: BACKGROUND
  The purpose of this study was to reevaluate the ECG features of arrhythmogenic right ventricular dysplasia (ARVD). The second objective was to evaluate the sensitivity and specificity of the standard and newly proposed diagnostic ECG markers in the presence of a right bundle-branch block (RBBB).
  
  
  RESULTS
  One hundred patients with ARVD (57 men; aged 39+/-15 years) and 57 controls (21 men; aged 40+/-17 years) were included. Among the 100 patients with ARVD, a complete RBBB was present in 17 patients, and 15 patients had an incomplete RBBB. T-wave inversion through V(3) demonstrated optimal sensitivity and specificity in both ARVD patients without a complete RBBB or incomplete RBBB (71% [95% confidence interval, 58% to 81%] and 96% [95% confidence interval, 81% to 100%], respectively) and in ARVD patients with incomplete RBBB (73% [95% confidence interval, 45% to 92%] and 95% [95% confidence interval, 77% to 100%], respectively). Between ARVD patients and controls with a complete RBBB, the only 2 parameters that differed were the prevalence of T-wave inversion through V(4) (59% versus 12%, respectively; P<0.05) and an r'/s ratio in V(1) <1 (88% versus 14%, respectively; P<0.005). In ARVD patients with complete RBBB, the most sensitive and specific parameter was an r'/s ratio <1.
  
  
  CONCLUSIONS
  We evaluated comprehensively the diagnostic value of ECG markers for ARVD. On the basis of the findings, we propose an algorithm, with examination of QRS morphology being the first step, for ECG evaluation of ARVD patients. Definite criteria are then applied on the basis of the presence of no RBBB, incomplete RBBB, and complete RBBB to obtain the best diagnostic utility of the ECG.
authors.affiliation: Carnegie 530, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21287, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Jain
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Amy
authors.initials: A
authors.lastname: Daly
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.forename: Cynthia
authors.initials: C
authors.lastname: James
authors.forename: Ariana
authors.initials: A
authors.lastname: Evenson
authors.forename: Rohit
authors.initials: R
authors.lastname: Jain
authors.forename: Theodore
authors.initials: T
authors.lastname: Abraham
authors.forename: Boon Yew
authors.initials: BY
authors.lastname: Tan
authors.forename: Hari
authors.initials: H
authors.lastname: Tandri
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Daniel
authors.initials: D
authors.lastname: Judge
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D000328:Adult; D000465:Algorithms; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity