Protocol for obtaining ECG in patients with suspected ARVD

1. Rhythm strips should be obtained of the precordial leads V1-V6 at double speed (50mm/s) and double amplitude (20mm/mv) in order to compare the duration of the QRS complex in different leads as well as to record a discrete wave following the QRS complex called the epsilon wave.

2. Rhythm strips should be obtained of leads I-AVF at double speed (50mm/s) and double amplitude (20mm/mv). Place the left arm lead over the xyphoid process, the right arm lead on the manubrium sternum and the left leg lead over a rib at the V4 or V5 position in order to elicit the epsilon wave.

Localized prolongation of

QRS interval in V1–V3

QRS interval in V4–V6

greater than 1.2 has been found in nearly 97% of cases with ARVD. The sensitivity of this QRS diagnostic criterion has not been established in patients who do not have overt manifestation of this disease.