Background: Electrocardiographic (ECG) findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) are limited to small case series.Objectives: This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data.Methods: We reviewed data of 54 consecutive ALVC patients (32 men, age 39 +/- 15 years) and compared them with 84 healthy controls with normal cardiac magnetic resonance.Results: T-wave inversion was often noted (57.4%), particularly in the inferior and lateral leads. Low QRS voltages in limb leads were observed in 22.2% of patients. The following novel ECG findings were identified: left posterior fascicular block (LPFB) (20.4%), pathological Q waves (33.3%), and a prominent R-wave in V-1 with a R/S ratio >= 0.5 (24.1%). The QRS voltages were lower in ALVC compared with controls, particularly in lead I and II. At receiver-operating characteristic analysis, the sum of the R-wave in I to II <= 8 mm (AUC: 0.909; P < 0.0001) and S-wave in V-1 plus R-wave in V-6 <= 12 mm (AUC: 0.784; P < 0.0001) effectively discriminated ALVC patients from controls. It is noteworthy that 4 of the 8 patients with an apparently normal ECG were recognized by these new signs. Transmural late gadolinium enhancement was associated to LPFB, a R/S ratio >= 0.5 in V-1, and inferolateral T-wave inversion, and a ringlike pattern correlated to fragmented QRS, SV1+RV6 <= 12 mm, low QRS voltage, and desmoplakin alterations.Conclusions: Pathological Q waves, LPFB, and a prominent R-wave in V-1 were common ECG signs in ALVC. An R-wave sum in I to II <= 8 mm and SV1+RV6 <= 12 mm were specific findings for ALVC phenotypes compared with controls.
The Diagnostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy: Novel ECG Signs / Calò, Leonardo; Crescenzi, Cinzia; Martino, Annamaria; Casella, Michela; Romeo, Fabiana; Cappelletto, Chiara; Bressi, Edoardo; Panattoni, Germana; Stolfo, Davide; Targetti, Mattia; Toso, Elisabetta; Musumeci, Maria Beatrice; Tini, Giacomo; Ciabatti, Michele; Stefanini, Matteo; Silvetti, Elisa; Stazi, Alessandra; Danza, Maria Ludovica; Rebecchi, Marco; Canestrelli, Stefano; Fedele, Elisa; Lanzillo, Chiara; Fusco, Armando; Sangiuolo, Federica Carla; Oliviero, Giada; Radesich, Cinzia; Perotto, Maria; Pieroni, Maurizio; Golia, Paolo; Mango, Ruggiero; Gasperetti, Alessio; Autore, Camillo; Merlo, Marco; de Ruvo, Ermenegildo; Russo, Antonio Dello; Olivotto, Iacopo; Sinagra, Gianfranco; Gaita, Fiorenzo. - In: JACC. CLINICAL ELECTROPHYSIOLOGY. - ISSN 2405-500X. - STAMPA. - 9:(2023), pp. 2615-2627. [10.1016/j.jacep.2023.08.020]
The Diagnostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy: Novel ECG Signs
Targetti, Mattia;Stefanini, Matteo;Pieroni, Maurizio;Olivotto, Iacopo;Sinagra, Gianfranco;
2023
Abstract
Background: Electrocardiographic (ECG) findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) are limited to small case series.Objectives: This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data.Methods: We reviewed data of 54 consecutive ALVC patients (32 men, age 39 +/- 15 years) and compared them with 84 healthy controls with normal cardiac magnetic resonance.Results: T-wave inversion was often noted (57.4%), particularly in the inferior and lateral leads. Low QRS voltages in limb leads were observed in 22.2% of patients. The following novel ECG findings were identified: left posterior fascicular block (LPFB) (20.4%), pathological Q waves (33.3%), and a prominent R-wave in V-1 with a R/S ratio >= 0.5 (24.1%). The QRS voltages were lower in ALVC compared with controls, particularly in lead I and II. At receiver-operating characteristic analysis, the sum of the R-wave in I to II <= 8 mm (AUC: 0.909; P < 0.0001) and S-wave in V-1 plus R-wave in V-6 <= 12 mm (AUC: 0.784; P < 0.0001) effectively discriminated ALVC patients from controls. It is noteworthy that 4 of the 8 patients with an apparently normal ECG were recognized by these new signs. Transmural late gadolinium enhancement was associated to LPFB, a R/S ratio >= 0.5 in V-1, and inferolateral T-wave inversion, and a ringlike pattern correlated to fragmented QRS, SV1+RV6 <= 12 mm, low QRS voltage, and desmoplakin alterations.Conclusions: Pathological Q waves, LPFB, and a prominent R-wave in V-1 were common ECG signs in ALVC. An R-wave sum in I to II <= 8 mm and SV1+RV6 <= 12 mm were specific findings for ALVC phenotypes compared with controls.
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