Arrhythmogenic right ventricular cardiomyopathy – evolution of electrocardiographic markers during long-term follow-up prior to ascertainment of diagnosis

Abstract Background Depolarization and repolarization abnormalities are part of the diagnostic Task Force Criteria 2010 (TFC2010) for arrhythmogenic right ventricular cardiomyopathy (ARVC). These thought to be progressive but have also been described as dynamic sometimes reversible. Evolution ECG prior clinical ARVC diagnosis is poorly studied. Objective To assess evolution depolarization characteristics in patients with identify markers disease progression at a preclinical stage. Methods 353 definite from Sweden, Denmark, Netherlands Canada least one 12-lead digital (65% males, 67% probands, 56% mutation carriers, median age 42 [IQR 29–53] years first 44 [30–55] years) were included. Digital ECGs extracted regional archives. left bundle branch block, pacing or recorded either 15 after heart transplantation excluded. Remaining 6,871 digitally processed automatically analysed using Glasgow algorithm. Median values overall QRS duration, terminal activation delay (TAD) lead V1 well amplitudes QRS-T-components precordial leads per patient year used analyses graphically represented Lowess smoothing cubic splines (Figure 1). Blue lines indicate smoothed conditional mean 95% confidence interval (shadow). Time “0” (red line) indicates time when TFC2010 fulfilled diagnosis. A database 18,564 anonymized (58% latest 41 32–52]) who contact health care during 2020–2021 was same exclusion criteria signal-processing methodology group reference (black line). Results TAD duration demonstrated significant increase before diagnosis, reductions seen QRS-T voltages measured R wave amplitude, amplitude (the absolute sum S wave), T (Table 1 Figure The changes all leads, not only right-sided, visually diverging controls. Conclusion Development phenotype started several continued afterwards. increased, decrease, decreased eventually leading inversion. might assessed available software. findings may clinically useful screening follow-up relatives. Funding Acknowledgement Type funding sources: Public hospital(s). Main source(s): Governmental research (ALF), Region Ostergotland, Sweden.The Swedish Heart-Lung Foundation.