EPSILON WAVE IN ECG AND ITS INTERPRETATION

EPSILON WAVE

1. EPSILON WAVE Dr.G.VENKATA RAMANA MBBS DNB FAMILY MEDICINE

2. DEFINITION Small deflection (“blip” or “wiggle”) buried in the end of the QRS complex On Standard 12-lead ECG (S-ECG), best seen in ST segment of V1 and V2, they are usually present in leads V1 through V4 Caused by post-excitation of myocytes in the right ventricle Characteristic finding in patients with  arrhythmogenic right ventricular dysplasia  (ARVD)

3. Epsilon wave in V1 due to RV conduction delay

4. Epsilon waves are the most specific and characteristic finding in  arrhythmogenic right ventricular dysplasia  (ARVD) In ARVD, myocytes are replaced by fat, producing islands of viable myocytes in a sea of fat This causes a delay in excitation of some of the myocytes of the right ventricle, producing a small “blip” seen during the ST segment of the ECG Epsilon waves have also been described in patients with: Posterior myocardial infarction Right ventricular infarction Infiltrative disease Sarcoidosis

5. ECG Examples of Epsilon Waves

6. Fontaine lead Comparison of S-ECG versus F-ECG in the ability to detect epsilon waves (arrows) The Fontaine lead placement increases sensitivity of detecting epsilon waves so that they are detected in three leads (FI, FII, FIII) rather than one lead in the regular placement