Epsilon Wave in Arrhythmogenic Cardiomyopathy

Re is a de Medicina Clínica 2024;08(01):e22042408004 Epsilon Wa e in A hy hmogenic Ca diomyopa hy Clinial Snapsho Luis López-Flo es1, Rocío Cóza -León1,2 and E nes o Díaz-In an e1 1Ca diac Elec ophysiology Uni , Depa men o Ca diology, Vi gen Maca ena Uni e si y Hospi al, Se ille, Spain 2Depa men o Medicine o he Uni e si y o Se ille, Se ille Recep ion da e o he manusc ip : 07/Sep iemb e/2023 Accep ance da e o he manusc ip : 16/Ab il/2024 Publica ion da e: 22/Ab il/2024 DOI: 10.5281/zenodo.14170391 C ea i e Commons: This wo k is licensed unde a C ea i e Commons A ibu ion-NonComme cial-NoDe i a i es 4.0 In e na ional License. Figu e 1: 12-lead elec oca diog am. A. Epsilon wa e. B. Ven icula ex asys oles. Con ac da a: Luis López-Flo es, A . D . Fed iani, 3, 41009 Se ille, Spain., Phone numbe : (+34) 955 00 80 00, [email p o ec ed] 1 EPSILON WAVE IN ARRHYTHMOGENIC CARDIOMYOPATHY LÓPEZ-FLORES, L. e al. AA 54-yea -old woman wi h hype ension p esen ed o he eme gency depa men a e syncope occu ed du - ing p olonged s anding. On a i al, hea a e and blood p es- su e we e no mal. Admission elec oca diog am (Figu e 1, A) showed sinus hy hm a 55 bpm, PR 200 ms, a wide QRS complex wi h mo phology o comple e igh bundle b anch block (wid h 180 ms), wi h small elec ical po en ials im- media ely a e he QRS in all leads, mo e a iega ed in igh p eco dial leads – indings sugges i e o epsilon wa e-, and a nega i e T wa e in all p eco dial leads. A subsequen elec o- ca diog am (Figu e 1, B) also e ealed en icula ex asys- oles o wo mo phologies, wi h c i e ia o epica dial o igin, and in which he low ampli ude componen a he end o he QRS was also app ecia ed. Echoca diog aphy showed se e e bi en icula sys olic dys unc ion and igh en icula (RV) apical akinesia. Ca diac magne ic esonance imaging con- i med he indings and u he e ealed a eas o RV dyski- nesia and la e gadolinium enhancemen a he subepica dial le el o bo h en icles. Co ona y angiog aphy showed no co ona y lesions. Wi h he diagnosis o a hy hmogenic ca - diomyopa hy, an implan able ca dio e e de ib illa o was implan ed o p ima y p e en ion. Epsilon wa e is a majo c i e ion o he diagnosis o a - hy hmogenic ca diomyopa hy and e lec s a delay in en- icula depola iza ion due o eplacemen o myoca dial ibe s by ib oadipose issue.1The p esence o epsilon wa es beyond he igh p eco dial leads is excep ional; howe e , in pa ien s wi h le en icula in ol emen , he epsilon wa e may be eco ded in he le and/o in e io leads,2as illus- a ed in his case. FUNDING pa ag aph The au ho s o his pape did no ecei e any und- ing om any public, comme cial o non-p o i agency o ounda ion. CONFLICT OF INTEREST pa ag aph The au ho s decla e o espec he e hical p inci- ples o esea ch and o be ee o any con lic o in e es . REFERENCES [1] Co ado D, Zo zi A, Cip iani A, Bauce B, Ba iani R, Be agna G, e al. E ol ing diagnos ic c i e ia o a hy hmogenic ca - diomyopa hy. J Am Hea Assoc. 2021;10(18):1–17. [2] Nunes De Alenca Ne o J, Ba anchuk A, Bayés-Genís A, Bayés De Luna A. A hy hmogenic igh en icula dyspla- sia/ca diomyopa hy: An elec oca diog am-based e iew. Eu- opace. 2018;20(FI1): 3–12. 2