Intracardiac Correlate of the Epsilon Wave in a Patient With Arrhythmogenic Right Ventricular Dysplasia

Abstract

A 29-year-old man with no significant past medical history presented to the emergency department of a local hospital with complaints of dyspnea and palpitations. A 12-lead ECG was obtained, revealing a wide complex tachycardia (QRS duration 160 ms) at a rate of 196 beats per minute with a right bundle-branch block morphology and left axis deviation. In the emergency department, the ECG was thought to represent supraventricular tachycardia, and the patient was given adenosine and diltiazem intravenously. This did not terminate or change the rate of the tachycardia. He was then given metoprolol 5 mg intravenously, and the tachycardia slowed and terminated. A 12-lead ECG in normal sinus rhythm is shown (Figure 1). Figure 1. Twelve-lead ECG in normal sinus rhythm. The findings include right atrial abnormality, normal QRS axis, anteroseptal Q waves, and precordial T-wave inversions. The most striking finding is the presence of an epsilon wave (black arrow) in V1 and V2. A …