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Epsilon wave

MedGen UID:
1815063
•Concept ID:
C5706157
•
Finding
HPO: HP:0034304

Definition

An electric signal of depolarization observed between the end of the QRS complex and the beginning of the T wave. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVEpsilon wave

Conditions with this feature

Arrhythmogenic right ventricular dysplasia 9
MedGen UID:
373205
•Concept ID:
C1836906
•
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
See: Condition Record
Arrhythmogenic right ventricular dysplasia 10
MedGen UID:
347543
•Concept ID:
C1857777
•
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy (ARVC) – previously referred to as arrhythmogenic right ventricular dysplasia (ARVD) – is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the right ventricle, and it may also involve the left ventricle. The presentation of disease is highly variable even within families, and some affected individuals may not meet established clinical criteria. The mean age at diagnosis is 31 years (±13; range: 4-64 years).
See: Condition Record
Arrhythmogenic right ventricular dysplasia 10
Arrhythmogenic right ventricular dysplasia 9

Recent clinical studies

Etiology

Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort.
Olivetti NQS, Sacilotto L, Wulkan F, D'Arezzo Pessente G, Lombardi Peres de Carvalho M, Moleta D, Tessariol Hachul D, Veronese P, Hardy C, Pisani C, Wu TC, Vieira MLC, de França LA, de Souza Freitas M, Rochitte CE, Bueno SC, Bastos Lovisi V, Krieger JE, Scanavacca M, da Costa Pereira A, da Costa Darrieux F
Circ Arrhythm Electrophysiol 2023 Feb;16(2):e011391. Epub 2023 Jan 31 doi: 10.1161/CIRCEP.122.011391. PMID: 36720007
Clinical features and arrhythmic complications of patients with pediatric-onset arrhythmogenic right ventricular dysplasia.
Sevinç Şengül F, Tunca Şahin G, Özgür S, Kafalı HC, Akıncı O, Güzeltaş A, Ergül Y
Anatol J Cardiol 2019 Aug;22(2):60-67. doi: 10.14744/AnatolJCardiol.2019.56985. PMID: 31375646Free PMC Article
Arrhythmogenic right ventricular dysplasia/cardiomyopathy: an electrocardiogram-based review.
Nunes de Alencar Neto J, Baranchuk A, Bayés-Genís A, Bayés de Luna A
Europace 2018 Jun 1;20(FI1):f3-f12. doi: 10.1093/europace/eux202. PMID: 29272363
Arrhythmogenic right ventricular cardiomyopathy: ECG progression over time and correlation with long-term follow-up.
Gallo C, Blandino A, Giustetto C, Anselmino M, Castagno D, Richiardi E, Gaita F
J Cardiovasc Med (Hagerstown) 2016 Jun;17(6):418-24. doi: 10.2459/JCM.0000000000000354. PMID: 27119598
Arrhythmogenic right ventricular dysplasia/cardiomyopathy. A review and update.
Francés RJ
Int J Cardiol 2006 Jun 28;110(3):279-87. Epub 2005 Aug 15 doi: 10.1016/j.ijcard.2005.07.004. PMID: 16099519

Diagnosis

Palpitations in a middle-aged male… Searching a needle in a haystack.
Thakur A, Kapil A, Singh S
Eur J Intern Med 2022 Apr;98:107-108. Epub 2022 Jan 10 doi: 10.1016/j.ejim.2022.01.005. PMID: 35027268
Challenging Cases of Wide Complex Tachycardias: Use and Limits of Algorithms.
Tordini A, Leonelli FM, De Ponti R, Bagliani G, Donzelli S, Lazzari L, Marini C, Pirrami MM, Carreras G
Card Electrophysiol Clin 2019 Jun;11(2):301-314. Epub 2019 Apr 10 doi: 10.1016/j.ccep.2019.02.008. PMID: 31084852
An epsilon wave on electrocardiogram.
Petrov DB
BMJ 2018 Jun 7;361:k1673. doi: 10.1136/bmj.k1673. PMID: 29880694
The electrocardiographic manifestations of arrhythmogenic right ventricular dysplasia.
Zhang L, Liu L, Kowey PR, Fontaine GH
Curr Cardiol Rev 2014 Aug;10(3):237-45. doi: 10.2174/1573403x10666140514102928. PMID: 24827798Free PMC Article
Ablation-induced epsilon wave.
Caldwell J, Redfearn D, Chiale PA, Baranchuk A
Heart Rhythm 2013 Nov;10(11):1737-8. Epub 2012 Aug 29 doi: 10.1016/j.hrthm.2012.08.038. PMID: 23102627

Therapy

Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave.
Fontaine GH, Duthoit G, Li G, Andreoletti L, Gandjbakhch E, Frank R
Europace 2017 Jul 1;19(7):1084-1090. doi: 10.1093/europace/euw320. PMID: 28062531
Proof of an association between Morbus Ebstein and arrhythmogenic cardiomyopathy in a patient with chronic atrial fibrillation.
Peters S
Int J Cardiol 2016 Jul 15;215:436-7. Epub 2016 Apr 14 doi: 10.1016/j.ijcard.2016.04.115. PMID: 27131266
Ablation-induced epsilon wave.
Caldwell J, Redfearn D, Chiale PA, Baranchuk A
Heart Rhythm 2013 Nov;10(11):1737-8. Epub 2012 Aug 29 doi: 10.1016/j.hrthm.2012.08.038. PMID: 23102627
Clinical study of 39 Chinese patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.
Ma KJ, Li N, Wang HT, Chu JM, Fang PH, Yao Y, Ma J, Hua W, Zhang S, Wang FZ, Li Z, Pu JL
Chin Med J (Engl) 2009 May 20;122(10):1133-8. PMID: 19493458
Serial reevaluation for ARVD/C is indicated in patients presenting with left bundle branch block ventricular tachycardia and minor ECG abnormalities.
Kiès P, Bootsma M, Bax JJ, Zeppenfeld K, van Erven L, Wijffels MC, van der Wall EE, Schalij MJ
J Cardiovasc Electrophysiol 2006 Jun;17(6):586-93. doi: 10.1111/j.1540-8167.2006.00442.x. PMID: 16836703

Prognosis

Arrhythmogenic right ventricular dysplasia/cardiomyopathy: an electrocardiogram-based review.
Nunes de Alencar Neto J, Baranchuk A, Bayés-Genís A, Bayés de Luna A
Europace 2018 Jun 1;20(FI1):f3-f12. doi: 10.1093/europace/eux202. PMID: 29272363
Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave.
Fontaine GH, Duthoit G, Li G, Andreoletti L, Gandjbakhch E, Frank R
Europace 2017 Jul 1;19(7):1084-1090. doi: 10.1093/europace/euw320. PMID: 28062531
A case of arrhythmogenic right ventricular cardiomyopathy-Naxos disease.
Saravanan RR, Amuthan V, Janarthanan RA, Balasubramanian S, Mohamed SN
Indian Heart J 2012 Jan-Feb;64(1):84-7. Epub 2012 Mar 26 doi: 10.1016/S0019-4832(12)60017-0. PMID: 22572432Free PMC Article
Arrhythmogenic right ventricular cardiomyopathy/dysplasia in Iraq.
Al-Hamdi A, Al-Kinani TA, Al-Khafaji AT, Hamed MB, Al-Mayahi MH, Al-Sudani NH
Cardiol J 2010;17(2):172-8. PMID: 20544617
Arrhythmogenic right ventricular dysplasia/cardiomyopathy. A review and update.
Francés RJ
Int J Cardiol 2006 Jun 28;110(3):279-87. Epub 2005 Aug 15 doi: 10.1016/j.ijcard.2005.07.004. PMID: 16099519

Clinical prediction guides

Epsilon Waves as an Extreme Form of Depolarization Delay: Focusing on the Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.
Platonov PG, Svensson A
Curr Cardiol Rev 2021;17(1):17-23. doi: 10.2174/1573403X16666200810105029. PMID: 32778035Free PMC Article
Arrhythmogenic right ventricular dysplasia/cardiomyopathy: an electrocardiogram-based review.
Nunes de Alencar Neto J, Baranchuk A, Bayés-Genís A, Bayés de Luna A
Europace 2018 Jun 1;20(FI1):f3-f12. doi: 10.1093/europace/eux202. PMID: 29272363
Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave.
Fontaine GH, Duthoit G, Li G, Andreoletti L, Gandjbakhch E, Frank R
Europace 2017 Jul 1;19(7):1084-1090. doi: 10.1093/europace/euw320. PMID: 28062531
A case of arrhythmogenic right ventricular cardiomyopathy-Naxos disease.
Saravanan RR, Amuthan V, Janarthanan RA, Balasubramanian S, Mohamed SN
Indian Heart J 2012 Jan-Feb;64(1):84-7. Epub 2012 Mar 26 doi: 10.1016/S0019-4832(12)60017-0. PMID: 22572432Free PMC Article
Arrhythmogenic right ventricular cardiomyopathy/dysplasia in Iraq.
Al-Hamdi A, Al-Kinani TA, Al-Khafaji AT, Hamed MB, Al-Mayahi MH, Al-Sudani NH
Cardiol J 2010;17(2):172-8. PMID: 20544617

Recent systematic reviews

Genotype-phenotype relationship in patients with arrhythmogenic right ventricular cardiomyopathy caused by desmosomal gene mutations: A systematic review and meta-analysis.
Xu Z, Zhu W, Wang C, Huang L, Zhou Q, Hu J, Cheng X, Hong K
Sci Rep 2017 Jan 25;7:41387. doi: 10.1038/srep41387. PMID: 28120905Free PMC Article

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