Epsilon wave uncovered by exercise test in a patient with desmoplakin-positive arrhythmogenic right ventricular cardiomyopathy

Abstract

Epsilon waves are a major criterion for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) but are an insensitive sign. Recently, exercise testing has been shown to uncover epsilon waves in asymptomatic patients carrying mutations in the PKP2 gene. We describe a case of an asymptomatic carrier of a mutation in the DSP gene who had a normal baseline electrocardiogram and an exercise-induced epsilon wave. This finding suggests that exercise testing may be valuable for the diagnosis of ARVC and that exercise-induced epsilon waves may be found in various genetic subtypes of this disease.