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Review
. 2024 Jan;29(1):151-164.
doi: 10.1007/s10741-023-10358-7. Epub 2023 Oct 17.

Electrocardiographic abnormalities in patients with cardiomyopathies

Alberto Aimo  1   2 , Agnese Milandri  3 , Andrea Barison  4   5 , Andrea Pezzato  6 , Paolo Morfino  4 , Giuseppe Vergaro  4   5 , Marco Merlo  6 , Alessia Argirò  7 , Iacopo Olivotto  8 , Michele Emdin  4   5 , Gherardo Finocchiaro  9   10 , Gianfranco Sinagra  6 , Perry Elliott  11   12 , Claudio Rapezzi  11
Affiliations
Review

Electrocardiographic abnormalities in patients with cardiomyopathies

Alberto Aimo et al. Heart Fail Rev. 2024 Jan.

Abstract

Abnormalities in impulse generation and transmission are among the first signs of cardiac remodeling in cardiomyopathies. Accordingly, 12-lead electrocardiogram (ECG) of patients with cardiomyopathies may show multiple abnormalities. Some findings are suggestive of specific disorders, such as the discrepancy between QRS voltages and left ventricular (LV) mass for cardiac amyloidosis or the inverted T waves in the right precordial leads for arrhythmogenic cardiomyopathy. Other findings are less sensitive and/or specific, but may orient toward a specific diagnosis in a patient with a specific phenotype, such as an increased LV wall thickness or a dilated LV. A "cardiomyopathy-oriented" mindset to ECG reading is important to detect the possible signs of an underlying cardiomyopathy and to interpret correctly the meaning of these alterations, which differs in patients with cardiomyopathies or other conditions.

Keywords: Amyloidosis; Cardiomyopathy; ECG; Electrocardiogram; Hypertrophic cardiomyopathy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Possible electrocardiographic findings in patients with left ventricular hypertrophy. a 72-year-old man with transthyretin amyloidosis experiencing sudden cardiac death. The explanted heart shows massive septal hypertrophy, explaining the poor R wave progression and QS complexes in V2–V3. Negative T waves in the antero-lateral leads: b 55-year-old man with obstructive hypertrophic cardiomyopathy (HCM) and c 49-year-old man with apical HCM
Fig. 2
Fig. 2
Right bundle branch block and its mimics. ALVC/ARVC, arrhythmogenic left/right ventricular cardiomyopathy
Fig. 3
Fig. 3
Standard vs. cardiomyopathy (CMP)-oriented approach to electrocardiogram reading. Central Illustration Electrocardiographic findings in patients with a hypertrophic or dilated phenotype. ALVC/ARVC, arrhythmogenic left/right ventricular cardiomyopathy; AV, atrio-ventricular; CMP, cardiomyopathy; HCM, hypertrophic cardiomyopathy; LAMP2, lysosomal-associated membrane protein 2; LBBB, left bundle branch block; PRKAG2, protein kinase AMP-activated non-catalytic subunit gamma 2; RBBB, right bundle branch block; WPW, Wolff-Parkinson-White
See this image and copyright information in PMC

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