What is the morphology of the epsilon wave in the context of arrhythmogenic right ventricular cardiomyopathy?

In the context of arrhythmogenic right ventricular cardiomyopathy, the epsilon wave is characterized by a small positive deflection that follows the QRS complex. This wave is considered a unique electrocardiographic finding associated with the disease. Typically, it appears in the right precordial leads (V1 to V3) and indicates delayed ventricular activation and a potential underlying structural abnormality in the right ventricle.

This small positive deflection is thought to represent a prolonged activation time due to dysynchronous ventricular contraction resulting from altered myocardial substrate. Recognizing the epsilon wave is clinically important as it may help in the diagnosis of arrhythmogenic right ventricular cardiomyopathy, guiding further management and risk stratification in affected patients.