Electrocardiographic features of arrhythmogenic right ventricular dysplasia.
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.
Jain
Rahul
R
Carnegie 530, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21287, USA.
Dalal
Darshan
D
Daly
Amy
A
Tichnell
Crystal
C
James
Cynthia
C
Evenson
Ariana
A
Jain
Rohit
R
Abraham
Theodore
T
Tan
Boon Yew
BY
Tandri
Hari
H
Russell
Stuart D
SD
Judge
Daniel
D
Calkins
Hugh
H
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