Differential diagnosis of early repolarization and nonspecific ST-segment elevation

Abstract

During the last years, because of the emergence of new algorithms to identify the early repolarization, clinicians are confused to define it on electrocardiography (ECG). It is very important to define the patients who are at the higher risk of life threatening arrhythmias. Presence of early repolarization is accepted as an arrhythmogenic factor. Therefore, the differential diagnosis between early repolarization and nonspecific ST-segment elevation should be clearly identified. Recently, Dr. Stefan Peters [ [1] Peters S. Differentiation between arrhythmogenic cardiomyopathy and early repolarization pattern: a case report with these two entities. Int. J. Cardiol. 2016; 215: 132-134 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] reported an interesting case of a patient with both early repolarization and arrhythmogenic cardiomyopathy. However, we think that this finding may be due to not considering the diagnostic criteria of early repolarization which was recommended by the consensus document [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ]. According to consensus document [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ], the diagnosis of early repolarization should be made if all of the following criteria are met; a) presence of an end-QRS notch or slur on the downslope of a prominent R-wave. If there is a notch, it should lie entirely above the baseline. The onset of a slur must also be above the baseline, b) Jpeak (Jp) is ≥0.1 mV in 2 or more contiguous leads of the 12-lead ECG, excluding leads V1 to V3, and, c) QRS duration is <120 ms. In this interesting report by Dr. Peters [ [1] Peters S. Differentiation between arrhythmogenic cardiomyopathy and early repolarization pattern: a case report with these two entities. Int. J. Cardiol. 2016; 215: 132-134 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], first ECG (Fig. 1 in the case report) seems as ECG noise rather than early repolarization. Additionally, the second ECG (Fig. 2 in the case report) does not meet the all of the criteria recommended by consensus document. Therefore, ST-segment elavation in this patient's ECG should be defined as nonspecific ST-segment elevation rather than early repolarization. The consensus document also recommended this definition [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ]. Similar to our perspective, Biernacka et al. [ [3] Biernacka K.E. Piotr K. Krzysztof D. Olgierd W. Early repolarization in patients with arrhythmogenic right ventricular cardiomyopathy is not frequent phenomenon. Int. J. Cardiol. 2016; 222: 982-983 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] demonstrated that early repolarization in patients with arrhythmogenic right ventricular cardiomyopathy is not a frequent phenomenon when the new diagnostic criteria of the early repolarization are used for its definition.