Arrhythmogenic Right Ventricular Dysplasia (ARVD) ECG Review

The classic ECG findings in arrhythmogenic right ventricular dysplasia are inverted T waves in the right precordial leads (V1-V3) with an “epsilon wave” just after the QRS in lead V1, representing early afterdepolarizations or “late potentials.” The epsilon wave is frequently described as having a “grassy knoll” appearance. This can also be seen on a signal-averaged ECG.

Epsilon_Wave

ECG Examples:

References:

  1. Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, Sixth Edition, Saunders, Philadelphia, 2008.
  2. Surawicz B et al. ACC/AHA recommendations for the standardization and interpretation of the electrocardiogram. Circulation. 2009;119:e235-240.