POTD - The Epsilon Wave and ARVD Arrhythmogenic right ventricular dysplasia (ARVD):
ARVD is an inherited disease characterized by fibrofatty replacement of RV myocardium which becomes the arrhythmogenic focus. It is associated with paroxysmal ventricular arrhythmias and sudden cardiac death. It is the 2nd most common cause of sudden cardiac death in young people (<35yrs) after HOCM. It can present as syncope, palpitations, or sudden cardiac arrest on exertion. Inherited in autosomal dominant fashion, it affects men more than women (typically in those of Greek or Italian descent). The incidence is thought to be 1 in 5000.
Key EKG finding – The Epsilon wave:
The epsilon wave is a small positive notch at the end of the QRS complex. It is the characteristic finding in ARVD. Other EKG findings in leads V1-V3 are: TWI, prolonged S-wave upstroke, and QRS widening. Paroxysmal episodes of V-tach with LBBB patterns are also common.
https://lifeinthefastlane.com/ecg-library/basics/epsilon-wave/ for examples
Admit to cardiology for a full workup which includes cardiac MRI. Treatment: Antiarrhythmics and AICD
Source: Lifeinthefastlane.com ECG library.
