Prevalence of early repolarization pattern on a 12-lead baseline ECG in patients with syncope referred to syncope unit

Abstract

Early repolarization pattern (ERP) is a common ECG aspect in general population. However, it is also associated with sudden cardiac death (SCD). ERP consensus definition has been recently published in 2015. While syncope is a common occur, ERP prevalence using new diagnostic criteria n this population remains unknown. We sought to determine prevalence of ERP in patient referred to syncope unit. We retrospectively analyzed the baseline 12-lead ECG of 150 patients without structural heart disease eferred to syncope unit for confirmed syncope between January 2017 and December 2018. After complete evaluation, yncope were classified as reflex, hypotensive, cardiac or unexplained. RP was defined as he presence of an end-QRS slur or notch with Jp elevation ≥ 0.1 mV, in ≥ 2 contiguous leads, excluding V1 to V3 nd QRS duration < 120ms. All the ERP were confirmed by 2 independent physicians. ERP was identified in 19 (12.7%) patients. A slurring was observed in 8 (42.1%) patients, a notch in 7 (36.8%) and 4 (21.1%) had both notching and slurring. p elevation was 1.63 ± 0.68 mm, with 9 (47.4%) patients presenting Jp elevation ≥ 0.2 mV. ERP was localized in inferior ( n = 11(57.9%)), lateral ( n = 3(15.8%)) or in both inferior and lateral leads ( n = 5(26.3%)). It was associated with an ascendant ST-segment in 16 (84.2%) patients. Male and unexplained syncope were significantly more represented in patient with ERP, respectively 15 (79%) vs.62 (47.3%) ( P = 0.01) and 8 (42.1%) vs.19 (14.5%) ( P = 0.003). There was no difference between the two groups in term of age, number of syncope, family history of SCD, duration of syncopal history and injuries concomitant with syncope. ERP was present in 12.7% of patients referred to syncope unit for confirmed syncope. There was a higher rate of unexplained syncope and men in this group. Further studies are needed to determine prognosis of ERP in this population.