Epsilon Wave

Epsilon Wave Definition

The epsilon wave is a small positive deflection (‘blip’) buried in the end of the QRS complex. It is the characteristic finding in arrhythmogenic right ventricular dysplasia (ARVD).

ECG Examples of Epsilon Waves

Arrhythmogenic Right Ventricular Dysplasia (ARVD)

The ECG changes in Arrhythmogenic Right Ventricular Dysplasia include:

• Epsilon wave (most specific finding, seen in 30% of patients)
• T wave inversions in V1-3 (85% of patients)
• Prolonged S-wave upstroke of 55ms in V1-3 (95% of patients)
• Localised QRS widening of 110ms in V1-3
• Paroxysmal episodes of ventricular tachycardia with a LBBB morphology

ECG Examples

Example 1

12-lead ECG is a typical example of ARVD.

Example 2

Related Topics

• Arrhythmogenic right ventricular dysplasia
• Right ventricular outflow tract VT
• ECG Exigency 008 — Sudden Syncope on the Soccer Field

References

• Corrado D, Biffi A, Basso C, Pelliccia A, Thiene G. Twelve-lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med 2009; 43 :669-676. [PMID: 19734501]
• Perez Diez D, Brugada J. Diagnosis and Management of Arrhythmogenic Right Ventricular Dysplasia: An article from the E-Journal of the ESC Council for Cardiology Practice, European Society of Cardiology 2008.
  

ECG Library Basics

LITFL Further Reading

• ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
• ECG A to Z by diagnosis – ECG interpretation in clinical context
• ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
• 100 ECG Quiz – Self-assessment tool for examination practice
• ECG Reference SITES and BOOKS – the best of the rest

Advanced Reading

• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
• Wagner GS. Marriott’s Practical Electrocardiography 12e
• Chan TC. ECG in Emergency Medicine and Acute Care
• Rawshani A. Clinical ECG Interpretation
• Mattu A. ECG’s for the Emergency Physician
• Hampton JR. The ECG In Practice, 6e