The electrocardiogram in non-ischaemic-dilated cardiomyopathy

Abstract

This article summarizes the main electrocardiogram (ECG) findings in dilated cardiomyopathy (DCM) patients. Recent reports are described in the great 'pot' of DCM peculiar ECG patterns that are typical of specific forms of DCM. Patients with late gadolinium enhancement on CMR, who are at greatest arrhythmic risk, have also distinctive ECG features. Future studies in large DCM populations should evaluate the diagnostic and prognostic value of the ECG.

Keywords: Arrhythmias; Cardiac; Cardiomyopathy; Death; Dilated; ECG; Magnetic resonance imaging; Prognosis; Sudden.

Figure 1

ECG findings of two DCM patients with LGE on CMR. ECG performed in 21-year-old woman shows low QRS voltages in V4–V6, LPFB, with AQRS ≈ + 120° and a premature ventricular beat with RBBB morphology and right axis deviation suggesting an origin in the LV lateral wall (A). On CMR, LGE involves the sub-epicardial lateral wall (B and C, white arrows). A 41-year-old man with a history of ventricular arrhythmias and ventricular dysfunction shows on ECG pathological lateral q waves (D, blue boxes), tall R wave in V1 (red box), and anterior T wave inversion (asterisks); his CMR reveals biventricular dilation and a stria LGE pattern with sub-epicardial distribution, mainly involving the LV lateral wall (E and F, white arrows). CMR, cardiac magnetic resonance; DCM, dilated cardiomyopathy; LGE, late gadolinium enhancement; LPFB, left posterior fascicular block; LV, left ventricular; RBBB, right bundle branch block.

Figure 2

ECG findings of DCM patients with arrhythmic genotypes. First ECG evidence of asymptomatic slow atrial fibrillation in 48 years-old female with a familiar history of SCD carrying likely pathogenic mutation in LMNA gene (A). Basal ECG of a 33 years-old man with a missense mutation in LMNA gene (p.Arg190Trp) displays signs of septal remodelling, such as pathological Q waves in leads V1–V4, poor R-wave progression (R wave <3 mm) in leads V1–V3 and QRS fragmentation. Extremely low QRS voltages in precordial leads, diffuse flat T waves, premature ventricular beats with LBBB, and inferior axis morphology are also present (B). A 51-year-old man with FLNC mutation and familiar history of DCM shows on ECG negative TWI in infero-lateral leads (C). ECG performed in 61-year-old man with a PLN p.Arg14del mutation. The ECG shows very low QRS voltages in limb leads, flat T waves, and poor R wave progression in precordial leads (D). DCM, dilated cardiomyopathy; FLNC, filamin C; LBBB, left bundle branch block; LMNA, lamin A/C; LV, left ventricular; PLN, phospholamban; SCD, sudden cardiac death; TWI, T wave inversion.