Epsilon wave uncovered by exercise test in a patient with desmoplakin-positive arrhythmogenic right ventricular cardiomyopathy.
Epsilon waves are a major criterion for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) but are an insensitive sign. Recently, exercise testing has been shown to uncover epsilon waves in asymptomatic patients carrying mutations in the PKP2 gene. We describe a case of an asymptomatic carrier of a mutation in the DSP gene who had a normal baseline electrocardiogram and an exercise-induced epsilon wave. This finding suggests that exercise testing may be valuable for the diagnosis of ARVC and that exercise-induced epsilon waves may be found in various genetic subtypes of this disease.
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Arnon
A
Adler
Barwon Health, Geelong, Victoria, Australia.
Mark J
MJ
Perrin
Division of Cardiology, Toronto General Hospital, University of Toronto, Ontario, Canada.
Danna
D
Spears
Division of Cardiology, Toronto General Hospital, University of Toronto, Ontario, Canada. Electronic address: drmgollob@gmail.com.
Michael H
MH
Gollob
D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000235:genetics*; D051180:Desmoplakins / Q000235:genetics; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D051191:Plakophilins / Q000235:genetics*; D018570:Risk Assessment; D012720:Severity of Illness Index; D055815:Young Adult
D051180:Desmoplakins; C495337:PKP2 protein, human; D051191:Plakophilins