Epsilon wave: A review of historical aspects

Andrés Ricardo Pérez-Riera; Raimundo Barbosa-Barros; Rodrigo Daminello-Raimundo; Luiz Carlos de Abreu; Javier García-Niebla; Mauro José de Deus Morais; Kjell Nikus; Frank I Marcus

doi:10.1016/j.ipej.2019.02.003

Epsilon wave: A review of historical aspects

Indian Pacing Electrophysiol J. 2019 Mar-Apr;19(2):63-67. doi: 10.1016/j.ipej.2019.02.003. Epub 2019 Feb 21.

Authors

Andrés Ricardo Pérez-Riera¹, Raimundo Barbosa-Barros², Rodrigo Daminello-Raimundo³, Luiz Carlos de Abreu³, Javier García-Niebla⁴, Mauro José de Deus Morais⁵, Kjell Nikus⁶, Frank I Marcus⁷

Affiliations

¹ Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil. Electronic address: riera@uol.com.br.
² Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil.
³ Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
⁴ Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain.
⁵ Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Centro de Ciências da Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil.
⁶ Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland.
⁷ Sarver Heart Center, The University of Arizona Health Sciences Hospital, Tucson, AZ, USA.

Abstract

The epsilon wave of the electrocardiogram (ECG) together with fragmented QRS (fQRS), the terminal conduction delay, incomplete right bundle branch block (IRBBB) and complete/advanced RBBB (CRBBB) of peripheral origin are part of a spectrum of ventricular depolarization abnormalities of arrhythmogenic cardiomyopathy(AC). Although the epsilon wave is considered a major diagnostic criterion for AC since 2010 (AC Task Force Criteria), its diagnostic value is limited because it is a sign of the later stage of the disease. It would be more appropriate to say that the epsilon wave is a "hallmark" of AC, but is of low diagnostic sensitivity. Although the epsilon wave has high specificity for AC, it can be present in other pathological conditions. In this update we will cover the nomenclature, association with disease states and electrocardiographic aspects of the epsilon wave.

Keywords: Epsilon wave; Fontaine wave; Ventricular post-excitation wave.

Publication types

Review