Lone, Ajaz

Introduction: Epsilon wave, one of the major criteria for the diagnosis of arrhythmogenic cardiomyopathy (ACM), is present in only 30% of ACM patients. Fontaine Leads have been shown to facilitate the visualization of Epsilon waves. Hypothesis: Modified Fontaine leads may help in better visualization of Epsilon waves in ACM patients than standard Fontaine leads. Methods: We prospectively enrolled ACM patients under our follow-up. Fontaine and the modified Fontaine EKGs were recorded ( Figure 1A ). The duration and amplitude of Epsilon waves, when present, were measured. Duration-amplitude product (DAP) was computed and compared. Results: EKGs of seventeen patients were available for analysis. Four patients (24%) had an Epsilon wave on a 12 lead EKG. Thirteen patients (76%) had Epsilon waves either on 12 lead EKG or Fontaine modification leads. These 13 patients (10 males and 3 females; mean age: 40.5 ±13 years) were included in the analysis. ( Table 1 ) Epsilon waves were seen in 10 (77%) patients in Standard Fontaine Leads. In the rest of the modifications, Epsilon waves were seen in 85% (11), 77% (10), 80% (8), and 80% (8) in Right, Left, Right-Left, and Left-Right Fontaine leads, respectively. ( Table 1 ) In only one patient (8%), the Standard Fontaine Epsilon wave had maximum DAP. Right, Left, Right-Left, and Left-Right Fontaine leads had maximum DAP in 5 (39%), 3 (23%), 2 (20%), and 3 (30%) patients, respectively. Conclusions: A modified Fontaine lead position may facilitate the Epsilon wave visualization in patients suffering from ACM when standard EKG and Fontaine lead EKGs fail to do so. A well-designed randomized study may be needed to evaluate the utility of modified Fontaine Leads in ACM.