Abstract
Early repolarization indicates a distinct electrocardiographic phenotype affecting the junction between the QRS complex and the ST segment in inferolateral leads (inferolateral J-wave syndromes). It has been considered a benign electrocardiographic variant for decades, but recent clinical studies have demonstrated its arrhythmogenicity in a small subset, supported by experimental studies showing transmural dispersion of repolarization. Here we review the current knowledge and the issues of risk stratification that limit clinical management. In addition, we report on new mapping data of patients refractory to pharmacologic treatment using high-density electrogram mapping at the time of inscription of J wave. These data demonstrate that distinct substrates, delayed depolarization, and abnormal early repolarization underlie inferolateral J-wave syndromes, with significant implications. Finally, based on these data, we propose a new simplified mechanistic classification of sudden cardiac deaths without apparent structural heart disease.
Highlights
Repolarization indicates a distinct electrocardiographic phenotype affecting the junction between the QRS complex and the ST segment in inferolateral leads
This article focuses on J-wave syndromes (ECG) phenotype affecting the junction (J point or J wave) between the QRS complex and the ST segment in inferolateral leads
Mechanistic classification of ventricular fibrillation (VF) associated with apparently normal hearts The present review shows that similar ECG phenotypes may be caused by fundamentally different substrates
Summary
Depolarization versus repolarization abnormality underlying inferolateral J-wave syndromes: New concepts in sudden cardiac death with apparently normal hearts. We report on new mapping data of patients refractory to pharmacologic treatment using highdensity electrogram mapping at the time of inscription of J wave These data demonstrate that distinct substrates, delayed depolarization, and abnormal early repolarization underlie inferolateral J-wave syndromes, with significant implications. Repolarization indicates a distinct electrocardiographic (SHD).[7,8,9,10,11] This article focuses on J-wave syndromes (ECG) phenotype affecting the junction (J point or J wave) between the QRS complex and the ST segment in inferolateral leads It was initially described as a benign ECG finding or found in association with hypothermia.[1,2,3,4] Subsequently, affecting inferolateral leads and reviews the current knowledge and the limitations in risk stratification.
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