early repolarization

Benign Early Repolarization (anterior STE, ascending ST segment)

• The original definition of ER was ≥ 0.1 mV of concave ST elevation with or without J waves, in ≥ 2 anterolateral leads

  • • Thought to be prevalent in in 1-2 % of general population, with higher prevalence in blacks and young athletes

    • Historically considered a benign differential for STEMI and pericarditis

Malignant Early Repolarization (inferolateral J waves followed by horizontal or downsloping ST segment)

• An emerging definition, with inferolateral J wave notching or slurring at the end of the QRS complex

  • • More common than benign ER, (3-13% of general population)

    • Thought to be associated with increased risk of idiopathic VF (controversial), RR of arrhythmic death in the most recent meta-analysis on the topic is estimated at 1.7 (1.2-2.4)

      • • J waves in multiple leads (esp. inferior) and higher amplitude (≥0.2 mV) are associated with higher risk

        • J waves followed by horizontal or downsloping ST segments are also associated with higher risk

References:

1. Haïssaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358(19):2016-2023. PMID: 18463377

2. Perez MV, Friday K, Froelicher V. Semantic confusion: the case of early repolarization and the J point. Am J Med. 2012;125(9):843-844. PMID: 22340816

3. 1. MacFarlane PW, Antzelevitch C, Haissaguerre M, et al. The early repolarization pattern: A consensus paper. J Am Coll Cardiol. 2015;66(4):470-477. PMID: 26205599

4. Surawicz B, Macfarlane PW. Inappropriate and confusing electrocardiographic terms: J-wave syndromes and early repolarization. J Am Coll Cardiol. 2011;57(15):1584-1586. PMID: 21474037