title: Novel electrocardiographic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy.
abstract: OBJECTIVE
  In order to improve the electrocardiographic (ECG) diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC), we evaluated novel quantitative parameters of the QRS complex and the value of bipolar chest leads (CF leads) computed from the standard 12 leads.
  
  
  RESULTS
  We analysed digital 12-lead ECGs in 44 patients with ARVC, 276 healthy subjects including 44 age and sex-matched with the patients and 36 genotyped members of ARVC families. The length and area of the terminal S wave in V1 to V3 were measured automatically using a common for all 12 leads QRS end. T wave negativity was assessed in V1 to V6 and in the bipolar CF leads computed from the standard 12 leads. The length and area of the terminal S wave were significantly shorter, whereas the S wave duration was significantly longer in ARVC patients compared with matched controls. Among members of ARVC families, those with mutations (n = 15) had shorter QRS length in V2 and V3 and smaller QRS area in lead V2 compared with those without mutations (n = 20). In ARVC patients, the CF leads were diagnostically superior to the standard unipolar precordial leads. Terminal S wave duration in V1 >48 ms or major T wave negativity in CF leads separated ARVC patients from matched controls with 90% sensitivity and 86% specificity.
  
  
  CONCLUSIONS
  The terminal S wave length and area in the right precordial leads are diagnostically useful and suitable for automatic analysis in ARVC. The CF leads are diagnostically superior to the unipolar precordial leads.
authors.affiliation: St George's University of London, Cardiac & Vascular Sciences Research Centre, London, UK vbatchva@sgul.ac.uk.
authors.forename: Velislav N
authors.initials: VN
authors.lastname: Batchvarov
authors.affiliation: St George's University of London, Cardiac & Vascular Sciences Research Centre, London, UK St George's Hospital, London, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastiaenen
authors.affiliation: Heart Centre, Department of Cardiology, Academic Medical Centre-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pieter G
authors.initials: PG
authors.lastname: Postema
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.
authors.forename: Elaine N
authors.initials: EN
authors.lastname: Clark
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.affiliation: Heart Centre, Department of Cardiology, Academic Medical Centre-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.affiliation: St George's University of London, Cardiac & Vascular Sciences Research Centre, London, UK St George's Hospital, London, UK.
authors.forename: Elijah R
authors.initials: ER
authors.lastname: Behr
mesh_terms: D000200:Action Potentials; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D020022:Genetic Predisposition to Disease; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010641:Phenotype; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted
keywords: Arrhythmogenic right ventricular cardiomyopathy; Bipolar chest leads; CF leads; Electrocardiography; Negative T wave; Terminal S wave