LAUSR

Epicardially extending myocardial strands affected by the remodeling of arrhythmogenic right Introduction Arrhythmogenic right ventricular cardiomyopathy (ARVC) is pathologically characterized by fibrofatty replacements. It is reported that the subtricuspid/peritricuspid area and the left ventricular inferolateral wall may be the only affected regions in the early stages of ARVC. This lipomatous or lipofibromatous composition causes delayed excitation. This late conduction through diseased myocardium is described as an epsilon wave, which is included in the revised Task Force diagnostic criteria. Herein, we report a case of ARVC with epsilon wave, in which radiofrequency catheter ablation (RFCA) on left ventricular outflow tract (LVOT) eliminated the epsilon wave. ventricular cardiomyopathy may be the cause of the epsilon wave. Case report A 26-year-old Japanese man had a mild dilatation and dysfunction of the right ventricle (RV) on a medical checkup and was subsequently referred to our hospital. Cardiac magnetic resonance (CMR) imaging showed regional RV akinesis in the anterior wall, a mild increase in RV end-diastolic volume /body surface area ratio of 107.7 mL/m, and a reduced RV ejection fraction (RVEF) of 41.6%, but without late gadolinium enhancement (Figure 1). Electrocardiography (ECG) showed an epsilon wave and inverted T waves in the V1 and V2 leads, as well as an incomplete right bundle branch block (RBBB) (Figure 2A). Although the 12-lead ECG showed frequent ventricular extrasystoles, the Holter monitoring did not show 500 ventricular extrasystoles per