Epsilon Waves During Ventricular Tachycardia in a Case of Arrhythmogenic Right Ventricular Dysplasia

Abstract

Epsilon waves represent delay in depolarization of the right ventricular (RV) free wall and outflow tract in patients with arrhythmogenic RV dysplasia. Normally, the free wall of the RV is the last part of the heart to undergo depolarization.1 If there is selective damage of the RV free wall, the ECG may show features of delayed and anisotropic conduction in that region, which are most pronounced in the anterior chest leads. Epsilon waves are low amplitude and are visible only on the ECG leads overlying the RV.2 This is the case of a 46-year-old man who was resuscitated after cardiac arrest caused by sustained monomorphic ventricular tachycardia (VT). Cardiac magnetic resonance imaging showed a dilated RV with fatty infiltration of the RV free wall with mild RV dysfunction. A mural dissection of the interventricular septum was also noted in the magnetic resonance imaging (Figure 1A). Computed …