Khaji Amanulla, Zhang Li, Kowey Peter, Martinez-Lage Maria, Kocovic Dusan
Lankenua Medical Centre, Wynnewood, PA, USA.
J Electrocardiol. 2013 Nov-Dec;46(6):524-7. doi: 10.1016/j.jelectrocard.2013.08.007. Epub 2013 Sep 7.
Epsilon wave, the post-excitation small squiggles at the beginning of ST segment that first named by Fontaine, is a well-known ECG phenomenon frequently associated with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Epsilon waves are caused by post excitation of the myocytes in the right ventricle due to myocardial scaring. Increasing evidence suggests that cardiac sarcoidosis might produce the pathological substrate required for production of epsilon waves. Therefore differentiating these two entities is of paramount clinical importance. Here we report a case demonstrating mega-epsilon wave, right ventricular dilatation and inducible ventricular tachycardia (VT) that was initially diagnosed as ARVD/C by the Task Force Criteria. However after a thorough evaluation, diagnosis of cardiac sarcoidosis was confirmed by the evidence of non-caseating granulomas from endomycardial biopsy.
ε波是Fontaine首次命名的ST段起始处兴奋后的微小波动，是一种众所周知的心电图现象，常与致心律失常性右室发育不良/心肌病（ARVD/C）相关。ε波是由于心肌瘢痕导致右室心肌细胞兴奋延迟所致。越来越多的证据表明，心脏结节病可能产生ε波形成所需的病理基础。因此，区分这两种疾病具有至关重要的临床意义。在此，我们报告一例表现为巨大ε波、右室扩张和可诱发室性心动过速（VT）的病例，该病例最初根据工作组标准被诊断为ARVD/C。然而，经过全面评估，心内膜活检发现非干酪样肉芽肿，从而确诊为心脏结节病。
