[SCD-FORUM] 122E RE: Case: Male, 29yrs. Dr. Zhu's ECGs. Dr. Zhang

[SCD Symposium]

Dear Dr. Zhu:

  Since I'm interested in using a series ECG markers for ARVD prediction, following I would like to provide my point of view about ECGs of your case.

1. For the ECG without PVCs,  the QRSD in V1+V2+V3/V4+V5+V6 >25 ms and we see pathologic Q waves in V1-2 although the T wave is upright in RV leads and inverted in LV precordial leads. 

2. For the ECGs with one PVC in precordial ECGs, QRS silons (notified by my ARVD mentor Dr. Guy Fontaine in many ARVD patients recently) and the classic epsilon waves are the most prominent in the RV leads. The PVC is probably originated from RV apex. 

By ECG evaluation alone, we see a strong evidence of RV cardiomyopathy. Syncope due to RV ventricular arrhtymias is the primary complain. With RV enlargement and the histological result, this patient meets the Task Force Criteria for ARVD/C diagnosis. 

The QRS silons and epsilon waves suggest the significant myocardial damage due to the disease progression. Thus I'm not supprised that his ventricular arrhythmia is hard to treat. Although he has no arrhythmias during and post exercise, extremely physical activities should be limited because it may speed up the disease progression. I wish he could have an  ICD for sudden arrhythmic death prevention in addition to the drug therapy. 
 
Thank you  very much for sharing those ECGs with our SCD-forum participants.

Li Zhang, MD
Assistant Professor, University of 
Utah School of Medicine
Dept. of Medicine, LDS Hospital
324 10th Avenue, Suite 130 
Salt Lake City, UT 84103
U.S.A.
Tel: 1-801-408-5015
Fax: 1-801-408-2361
ldlzhang at gmail.com