QRS fragmentation in standard ECG as a diagnostic marker of arrhythmogenic right ventricular dysplasia–cardiomyopathy

Background Epsilon potentials in right precordial leads are reliable diagnostic electrocardiographic (ECG) criteria of arrhythmogenic right ventricular dysplasia-cardiomyopathy (ARVD/C). Sensitivity of epsilon potentials can be enhanced by highly amplified and modified ECG recording technique. Nevertheless, in many cases the definition of epsilon potentials remains difficult. Objective To overcome these limitations, the value of QRS fragmentation in a standard 12-lead ECG was analyzed in 360 patients with ARVD/C (176 men, mean age 47.3 ± 13.7 years). Methods Analysis of QRS fragmentation of the whole collective of patients was compared with the detection of epsilon potentials in highly amplified right precordial and modified limb leads in a subgroup of 207 patients. Fifty-two phenotypically and genotypically nonaffected subjects from systematic family screening in 10 families with known plakophilin-2 and desmoplakin mutations served as a control group. Results QRS fragmentation could be found in a total of 306 of 360 patients (85%); 2.09 ± 1.8 fragmented QRS complexes (range 1 to 7) could be found per patient. Fragmented QRS complexes in only 1 right precordial lead were found in 106 cases. In 190 cases, QRS fragmentation was present in more than 1 lead, including all 12 standard leads. Epsilon potentials in highly amplified right precordial and modified limb leads could be found in a total of 159 cases (77%). Typical epsilon potentials in highly amplified right precordial leads could be found in 97 cases (47%). Conclusion QRS fragmentation in ARVD/C has a high diagnostic value similar to epsilon potentials by a highly amplified and modified recording technique.