Concealed electrocardiographic features in arrhythmogenic cardiomyopathy

Introduction Arrhythmogenic cardiomyopathy is a life-threatening primary electrical disease with the potential of sudden cardiac death at the first manifestation of the disease. That is why it is very important to identify the disease as early as possible. Standard ECG may describe arrhythmogenic cardiomyopathy with different markers: T-wave inversions as a marker of right ventricular dilatation [1], Epsilon waves as a marker of pronounced right ventricular outflow tract involvement [2], QRS fragmentation in inferior leads as a marker of inferior wall involvement [3], Localized right ventricular QRS prolongation as a marker of parietal block [4], Low voltage as a marker of advanced disease, in most cases caused by phospholamban mutations [1]. In the meantime, several ECG abnormalities have been described as features of concealed arrhythmogenic cardiomyopathy at the very early stage of the disease (prehistologic phase).