The Role of Lead aVR and Lead V1 in the Diagnosis of Arrhythmogenic Cardiomyopathy in Apparently Normal Hearts

Arrhythmogenic cardiomyopathy is electrocardiographically characterized by right precordial T-wave inversions and epsilon waves as major criteria. Additionally, terminal activation delay of 55 ms or more serves as a minor criterion. Although ther are more and more evident pathological data of right ventricles without dilatation or aneurysm, typical fibrofatty abnormalities and myocardial atrophy exist. The ECGs of these patients lack the right precordial T-wave inversion and epsilon waves. Lead aVR and lead V1 could become more and more relevant. 413 cases with arrhythmogenic cardiomyopathy (292 males, mean age 46.3 ± 11.6 years) and a collective of normal proband (1496 patients, 859 males with an age range of 18 - 81 years) were analyzed with regard to ECG appearance of lead aVR and the amplitude of inverted T-waves in lead V1. With a specificity of 99.9%, a positive predictive value of 99.7% and a negative predictive value of 98% lead V1 and aVR were most relevant to diagnose arrhythmogenic cardiomyopathy if an amplitude of Q waves of 3mm or more, R waves of 2 mm or less, inverted T waves of 2 mm or less in lead aVR and inverted T waves in lead V1 were present. These two leads appear most relevant to make the diagnosis of arrhythmogenic cardiomyopathy even in cases without right ventricular dilatation and right ventricular aneurysms.