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

Epsilon Waves
epsilon-wave-IIb-590x250 2
epsilon-V1b-590x182 2
ARVD Epsilon

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

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) ECG ARVD

12-lead ECG is a typical example of ARVD.

Prolonged S-wave upstroke in ARVD

Prolonged S-wave upstroke in ARVD

Example 2

Arrhythmogenic Right Ventricular Dysplasia (ARVD) 002

VT with LBBB morphology due to ARVD

Related Topics


ECG Library Basics

LITFL Further Reading

Advanced Reading




Posted by Dr Ed Burns

Dr Ed Burns . Emergency Physician in Pre-hospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education. Ed is the force behind the LITFL ECG library | + Edward Burns | @edjamesburns

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