{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:15:02Z","timestamp":1769001302835,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T00:00:00Z","timestamp":1456358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>EAM Correlates of Depolarization in ARVD<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Epsilon waves and other depolarization abnormalities in the right precordial leads are thought to represent delayed activation of the right ventricular outflow tract in arrhythmogenic right ventricular dysplasia\/cardiomyopathy (ARVD\/C). However, no study has directly correlated cardiac electrical activation with the surface ECG findings in ARVD\/C.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Thirty ARVD\/C patients (mean age 32.7 \u00b1 11.2\u00a0years, 16 men) underwent endocardial and epicardial electroanatomical activation mapping in sinus rhythm. Twelve\u2010lead ECGs were classified into 5 patterns: (1) normal QRS (11 patients); (2) terminal activation delay (TAD) (3 patients); (3) incomplete right bundle branch block (IRBBB) (5 patients); (4) epsilon wave (5 patients); (5) complete right bundle branch block (CRBBB) (6 patients). Timing of local ventricular activation and extent of scar was then correlated with surface QRS. Earliest endocardial and epicardial RV activation occurred on the mid anteroseptal wall in all patients despite the CRBBB pattern on ECG. Total RV activation times increased from normal QRS to prolonged TAD, IRBBB, epsilon wave, and CRBBB, respectively (103.9 \u00b1 5.6, 116.3 \u00b1 6.5, 117.8 \u00b1 2.7, 146.4 \u00b1 16.3, and 154.3 \u00b1 6.3, respectively, P &lt; 0.05). The total epicardial scar area (cm<jats:sup>2<\/jats:sup>) was similar among the different ECG patterns. Median endocardial scar burden was significantly higher in patients with epsilon waves even compared with patients with CRBBB (34.3 vs. 11.3 cm<jats:sup>2<\/jats:sup>, P &lt; 0.01). Timing of epsilon wave corresponded to activation of the subtricuspid region in all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found that epsilon waves are often associated with severe conduction delay and extensive endocardial scarring in addition to epicardial disease. The timing of epsilon waves on surface ECG correlated with electrical activation of the sub\u2010tricuspid region.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.12925","type":"journal-article","created":{"date-parts":[[2016,1,12]],"date-time":"2016-01-12T14:24:13Z","timestamp":1452608653000},"page":"443-452","source":"Crossref","is-referenced-by-count":38,"title":["Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia\/Cardiomyopathy"],"prefix":"10.1111","volume":"27","author":[{"given":"TANYANAN","family":"TANAWUTTIWAT","sequence":"first","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANNELINE S.J.M.","family":"TE RIELE","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Cardiology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BINU","family":"PHILIPS","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Cardiovascular Institute Warren Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CYNTHIA A.","family":"JAMES","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BRITTNEY","family":"MURRAY","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CRYSTAL","family":"TICHNELL","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ABHISHEK C.","family":"SAWANT","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"HUGH","family":"CALKINS","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"HARIKRISHNA","family":"TANDRI","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,2,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.65.2.384"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.840827"},{"key":"e_1_2_7_4_1","first-page":"page 631","volume-title":"Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease","author":"Issa Z","year":"2012"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12755"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.959080"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\/books\/12437"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.01.043"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000142293.60725.18"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.12.018"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.032"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.73.4.645"},{"key":"e_1_2_7_13_1","first-page":"539","article-title":"Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. 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