PROGRESSIVE ECG-CHANGES IN ARRHYTHMOGENIC RIGHT-VENTRICULAR DISEASE -EVIDENCE FOR AN EVOLVING DISEASE

Electrocardiography results were used to assess diagnosis and evolutio n of arrhythmogenic right ventricular disease. The initial ECG present ation and long-term changes were analysed in 74 consecutive patients w ith symptomatic ventricular tachycardia and arrhythmogenic right ventr icular disease. On first available tracings, a left axis deviation of the QRS was found in 18 patients. The QRS length in V-1 was greater th an or equal to 110 ms in 39 patients, an epsilon wave was present in 1 7, and a complete right bundle branch block in four patients. The T wa ve was negative in V-1-V-3 in 37 patients (50%).In 36 patients, long-t erm electrocardiographic follow-up of 9.5 +/- 3.2 years was available. During this period, ECG changes were observed in 20 patients (56%):ne gative T waves in 11 patients, a new left axis deviation in three, QRS enlargement in 13 (including eight right bundle branch block), right atrial hypertrophy in three, and paroxysmal or established atrial fibr illation in three.On studying all 110 ECG tracings (74 initial recordi ngs+36 follow-up ECGs), we found a strong correlation between QRS or T wave changes and the length of follow-up after the first symptom; mea n time interval between first ventricular tachycardia and ECG recordin g was significantly longer in patients with negative T waves in the ri ght precordial leads, QRS enlargement, or left axis deviation, than in patients without such abnormalities. ECG abnormalities were more freq uent at 10 year and 5 year follow-up than on initial tracings. A norma l ECG was found in 40% of patients during the first year of follow-up, 8% at 5 years, and never later than the 6th year. In conclusion: elec trocardiographic diagnosis of arrhythmogenic right ventricular disease may be difficult in the initial stage of the disease, since a normal ECG is found in up to 40% of patients. During the follow-up, progressi ve and characteristic ECG changes will occur. Arrhythmogenic right ven tricular disease can be excluded if the ECG is found to be normal 6 ye ars or later after a first ventricular tachycardia attack.