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Endgames Spot Diagnosis

An epsilon wave on electrocardiogram

BMJ 2018; 361 doi: (Published 07 June 2018) Cite this as: BMJ 2018;361:k1673
  1. Daniel B Petrov, consultant cardiologist
  1. Emergency Hospital “Pirogov,” Sofia, Bulgaria
  1. Correspondence to D B Petrov dpetrov{at}

A 39 year old man with no history of heart disease was admitted with symptoms of palpitations and weakness lasting for several hours. An electrocardiogram (ECG) showed a wide complex tachycardia with left bundle branch block morphology, consistent with sustained ventricular tachycardia of right ventricular origin. Because of continuing haemodynamic instability, the patient was cardioverted to sinus rhythm with a single 200 J shock. The post-cardioversion ECG (fig 1) showed inverted T-waves in leads V1-V3, with QRS complex duration of 112 ms, and prolonged S-waves upstroke of 55 ms. Increased amplitude ECG showed waves with a small spike upward in lead V …

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