An epsilon wave in arrhythmogenic right ventricular cardiomyopathy/dysplasia

A 53-year-old male presented to our emergency department with a sudden onset of ventricular tachycardia with left bundle branch block and right axis deviation. After the tachyarrhythmia converting to sinus rhythm, the ECG displayed sinus rhythm with a typical epsilon wave in leads V1 and V2. Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) was suspected. The epsilon wave is the most specific hallmark for the diagnosis of ARVD/C, although it is insensitive. For the management of these patients, antiarrhythmic medications appear to be effective. However, implantable cardioverter defibrillators are the only reliable treatment to prevent sudden cardiac death.