Division of Cardiology, Policlinico Casilino, Rome, Italy.
Division of Cardiology, Policlinico Casilino, Rome, Italy.
JACC Clin Electrophysiol. 2023 Dec;9(12):2615-2627. doi: 10.1016/j.jacep.2023.08.020. Epub 2023 Sep 27.
Electrocardiographic (ECG) findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) are limited to small case series.
This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data.
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.
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 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 plus R-wave in V ≤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, and inferolateral T-wave inversion, and a ringlike pattern correlated to fragmented QRS, SV+RV ≤12 mm, low QRS voltage, and desmoplakin alterations.
Pathological Q waves, LPFB, and a prominent R-wave in V were common ECG signs in ALVC. An R-wave sum in I to II ≤8 mm and SV+RV ≤12 mm were specific findings for ALVC phenotypes compared with controls.
心律失常性左心室心肌病（ALVC）的心电图（ECG）表现仅限于小病例系列。
本研究旨在分析 ALVC 患者的 ECG 特征，并将 ECG 与心脏磁共振和基因型数据相关联。
我们回顾了 54 例连续的 ALVC 患者（32 名男性，年龄 39 ± 15 岁）的数据，并将其与 84 例具有正常心脏磁共振的健康对照者进行了比较。
T 波倒置很常见（57.4%），尤其是在下壁和外侧导联。肢体导联低 QRS 电压见于 22.2%的患者。确定了以下新的 ECG 发现：左后束支阻滞（LPFB）（20.4%）、病理性 Q 波（33.3%）和 V 导联 R 波突出，R/S 比值≥0.5（24.1%）。与对照组相比，ALVC 的 QRS 电压较低，尤其是在 I 导联和 II 导联。在接受者操作特征分析中，I 导联至 II 导联的 R 波总和≤8 毫米（AUC：0.909；P<0.0001）和 V 导联的 S 波加 V 导联的 R 波总和≤12 毫米（AUC：0.784；P<0.0001）有效地将 ALVC 患者与对照组区分开来。值得注意的是，8 名心电图明显正常的患者中有 4 名被这些新标志识别出来。透壁性晚期钆增强与 LPFB、V 导联 R/S 比值≥0.5 和下外侧 T 波倒置相关，而环形模式与碎裂 QRS、SV+RV≤12 毫米、低 QRS 电压和桥粒蛋白改变相关。
病理性 Q 波、LPFB 和 V 导联的 R 波突出是 ALVC 的常见 ECG 征象。与对照组相比，I 导联至 II 导联的 R 波总和≤8 毫米和 SV+RV≤12 毫米是 ALVC 表型的特异性发现。
