This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: August 11, 2009, Volume 120, Number 6 All Versions of this Article: 120/6/477    most recent CIRCULATIONAHA.108.838821v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Jain, R. Articles by Calkins, H. PubMed PubMed Citation Articles by Jain, R. Articles by Calkins, H. Pubmed/NCBI databases Medline Plus Health Information Cardiomyopathy Related Collections Other heart failure Electrocardiology Related Article

(Circulation. 2009;120:477-487.)
© 2009 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia

Rahul Jain, MD; Darshan Dalal, MD; Amy Daly, MS; Crystal Tichnell, MGC; Cynthia James, PhD; Ariana Evenson, MHSA; Rohit Jain, MD; Theodore Abraham, MD; Boon Yew Tan, MBChB; Hari Tandri, MD; Stuart D. Russell, MD; Daniel Judge, MD; Hugh Calkins, MD

From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to Hugh Calkins, MD, Carnegie 530, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21287. E-mail hcalkins{at}jhmi.edu

Received December 1, 2008; accepted June 1, 2009.

Background— The purpose of this study was to reevaluate the ECG features of arrhythmogenic right ventricular dysplasia (ARVD). The second objective was to evaluate the sensitivity and specificity of the standard and newly proposed diagnostic ECG markers in the presence of a right bundle-branch block (RBBB).

Methods and Results— One hundred patients with ARVD (57 men; aged 39±15 years) and 57 controls (21 men; aged 40±17 years) were included. Among the 100 patients with ARVD, a complete RBBB was present in 17 patients, and 15 patients had an incomplete RBBB. T-wave inversion through V₃ demonstrated optimal sensitivity and specificity in both ARVD patients without a complete RBBB or incomplete RBBB (71% [95% confidence interval, 58% to 81%] and 96% [95% confidence interval, 81% to 100%], respectively) and in ARVD patients with incomplete RBBB (73% [95% confidence interval, 45% to 92%] and 95% [95% confidence interval, 77% to 100%], respectively). Between ARVD patients and controls with a complete RBBB, the only 2 parameters that differed were the prevalence of T-wave inversion through V₄ (59% versus 12%, respectively; P<0.05) and an r'/s ratio in V₁ <1 (88% versus 14%, respectively; P<0.005). In ARVD patients with complete RBBB, the most sensitive and specific parameter was an r'/s ratio <1.

Conclusions— We evaluated comprehensively the diagnostic value of ECG markers for ARVD. On the basis of the findings, we propose an algorithm, with examination of QRS morphology being the first step, for ECG evaluation of ARVD patients. Definite criteria are then applied on the basis of the presence of no RBBB, incomplete RBBB, and complete RBBB to obtain the best diagnostic utility of the ECG.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 120: 459-460. [Extract] [Full Text]