Inferior Early Repolarization Research Articles

Early Repolarization

Background— Early repolarization (ER) in inferior/lateral leads of standard ECGs increases the risk of arrhythmic death. We tested the hypothesis that variations in the ST-segment characteristics after the ER waveforms may have prognostic importance. Methods and Results— ST segments after ER were classified as horizontal/descending or rapidly ascending/upsloping on the basis of observations from 2 independent samples of young healthy athletes from Finland (n=62) and the United States (n=503), where ascending type was the dominant and common form of ER. Early repolarization was present in 27/62 (44%) of the Finnish athletes and 151/503 (30%) of the US athletes, and all but 1 of the Finnish (96%) and 91/107 (85%) of US athletes had an ascending/upsloping ST variant after ER. Subsequently, ECGs from a general population of 10 864 middle-aged subjects were analyzed to assess the prognostic modulation of ER-associated risk by ST-segment variations. Subjects with ER ≥0.1 mV and horizontal/descending ST variant (n=412) had an increased hazard ratio of arrhythmic death (relative risk 1.43; 95% confidence interval 1.05 to 1.94). When modeled for higher amplitude ER (>0.2 mV) in inferior leads and horizontal/descending ST-segment variant, the hazard ratio of arrhythmic death increased to 3.14 (95% confidence interval 1.56 to 6.30). However, in subjects with ascending ST variant, the relative risk for arrhythmic death was not increased (0.89; 95% confidence interval 0.52 to 1.55). Conclusions— ST-segment morphology variants associated with ER separates subjects with and without an increased risk of arrhythmic death in middle-aged subjects. Rapidly ascending ST segments after the J-point, the dominant ST pattern in healthy athletes, seems to be a benign variant of ER.

Clinical Prognosis of Early Repolarization on Electrocardiography in Survivors after out of Hospital Cardiopulmonary Arrest

Purpose: An early repolarization (ER) in inferior leads on electrocardiography (ECG) has been shown to be associated with an increased risk of ventricular arrhythmias. However, ECG findings on ER after resuscitation of cardiopulmonary arrest (CPA) subjects are unknown. Methods: Of 448 consecutive subjects with out-of-hospital CPA for the last 2 years, 118 subjects were resuscitated. Among them, 64 subjects (35 male, 76±14 years) who had no evident of acute ischemia or vascular deseases were evaluated and divided into two groups: 1) with early repolarization in inferior leads 2) without those findings. Baseline demographic, clinical and electrocardiographic characteristics were analyzed. Early repolarization was defined as >0.1 mV J-point elevation of the QRS-ST junction in at least two leads in inferior leads as QRS slurring or notching, and was stratified according to the degree of J-point elevation (>0.1 mV or >0.15 mV). Results: ER was detected in 23 subjects. There was no significant difference in patient baseline characteristics between two groups. However, 11 subjects with more than 0.15 mV J-point elevation of Group 1 had markedly lower in survival time than the Group 2 (2.8±3.7 vs 8.8±17.1 [days], P=0.045), and more than 5 days survival after resuscitation was significantly increased in Group 2 compared with those subjects in Group 1 (29 vs 18 [%], P=0.043). Conclusions: Greater degree of early repolarization in the inferior leads of ECG after resuscitation might suggest the poor prognosis in the CPA subjects.

A case report of idiopathic ventricular fibrillation with early repolarization in inferior leads

A case report of idiopathic ventricular fibrillation with early repolarization in inferior leads

Inferolateral early repolarization in athletes

Early repolarization (ER) has been considered a common benign ECG pattern among young athletes. In contrast, an inferolateral early repolarization pattern has been associated with an increased risk for sudden cardiac death (SCD). The aim of the study was to assess the prevalence of inferolateral ER among young collegiate athletes and to describe the characteristics associated to the pattern. We analyzed ECGs from 503 athletes (51% males; age range, 17-24). Information on gender, body weight, race, sport, and family history of SCD was collected. ER was defined as a slow deflection of the down slope of the R wave (≥0.1mV) or positive wave at J point (≥0.1mV) in two consecutive inferior or in lateral leads. Additionally, we included voltage measurements according to the Sokolow-Lyon criteria and RR interval measurement. The prevalence of ER was 30% (inferior, 20%; lateral, 21%; both, 11%). Male gender (59% vs. 48%, p = 0.019), left ventricular hypertrophy (LVH) voltage (39% vs. 12%, p < 0.001) was significantly associated with the ER pattern. In addition, there was a trend towards longer RR interval in the inferior ER group (p = 0.06) and there were slightly more African-Americans with ER compared to non-African-American (34% vs. 28%, p = 0.22). Among females (p = 0.039) and African-Americans (p = NS), the association of LVH to ER was not as strong. ER is a common finding among young athletes. The ECG marker of LVH is the dominant shared characteristic among the athletes with ER, along with male gender and a trend to greater prevalence among African-American athletes.

Early Repolarization: Not Just an Innocent Bystander?

Early repolarization is generally believed to be a benign finding in 12-lead electrocardiography; however, early repolarization in inferior leads has