Epsilon Wave

Epsilon Wave Epsilon wave, the classical ECG finding in arrhythmogenic right ventricular dysplasia is seen at the end of the QRS complex. Epsilon wave is typically seen in right precordial leads though it has been noted in left precordial leads in those with left ventricular involvement. ARVD is better termed arrhythmogenic cardiomyopathy because of the possibility of left ventricular involvement. Epsilon wave represents the delayed activation of surviving islands of myocardium within the fibrofatty tissue in ARVD [1]. Some have called it as a ‘post excitation’ wave, as a corollary to the delta wave in pre excitation. It has been mentioned that setting the low pass filter at 40 Hz may make the Epsilon wave less prominent and reduce chance of detection [2]. Low pass filter of 40 Hz is often seen as the default setting in ECG machines to remove artifacts due to myopotentials. Setting it at 150 Hz is useful to detect Epsilon waves as well as most of the pacemaker artifacts, which also get attenuated with low pass filter at 40 Hz. As Guy Fontaine discovered the Epsilon waves and named it so, some also call it as Fontaine waves. Fontaine leads can be used to enhance the detection of Epsilon waves. In one of them the right arm electrode is placed on the manubrium and the left arm electrode on the xiphoid, producing a bipolar chest lead. Recording at 20 mm/mV can enhance the sensitivity for detection of Epsilon waves [3]. Three Fontaine leads FI, FII and FIII have...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs