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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

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
Changes in follow-up ECG and signal-averaged ECG in patients with arrhythmogenic right ventricular cardiomyopathy.
Bae MH, Kim JH, Jang SY, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC
Pacing Clin Electrophysiol 2014 Apr;37(4):430-8. Epub 2013 Oct 25 doi: 10.1111/pace.12285. PMID: 24164254
Electrocardiographic pattern in arrhythmogenic right ventricular cardiomyopathy.
Steriotis AK, Bauce B, Daliento L, Rigato I, Mazzotti E, Folino AF, Marra MP, Brugnaro L, Nava A
Am J Cardiol 2009 May 1;103(9):1302-8. Epub 2009 Mar 18 doi: 10.1016/j.amjcard.2009.01.017. PMID: 19406276
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

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
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
Epsilon waves: Milestones in the discovery and progress.
Li GL, Saguner AM, Fontaine GH, Frank R
Ann Noninvasive Electrocardiol 2018 Nov;23(6):e12571. Epub 2018 Jul 5 doi: 10.1111/anec.12571. PMID: 29978588Free 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
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

Therapy

Epsilon Wave Masked by ST-Segment Elevation After Cardioversion From Sustained Ventricular Tachycardia: An Exceptional Manifestation of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
Kim S, Lee JH, Nho WY, Kim H
J Emerg Med 2022 Feb;62(2):254-259. Epub 2022 Jan 17 doi: 10.1016/j.jemermed.2021.10.033. PMID: 35058095
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
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
The presence of giant epsilon waves in a patient with arrhythmogenic right ventricular cardiomyopathy.
Bao H, Hong K, Li J, Cheng X
Ann Noninvasive Electrocardiol 2012 Jul;17(3):277-9. doi: 10.1111/j.1542-474X.2012.00519.x. PMID: 22816547Free PMC Article
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

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
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
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
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
Changes in follow-up ECG and signal-averaged ECG in patients with arrhythmogenic right ventricular cardiomyopathy.
Bae MH, Kim JH, Jang SY, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC
Pacing Clin Electrophysiol 2014 Apr;37(4):430-8. Epub 2013 Oct 25 doi: 10.1111/pace.12285. PMID: 24164254

Clinical prediction guides

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
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
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
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

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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