Prevalence Of Early Repolarization Pattern Research Articles

Evaluation of Early Repolarization Pattern in Children with Mitral Valve Prolapse.

Patients with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias and sudden cardiac death and presence early repolarization pattern (ERP) in electrocardiography may be predict for ventricle arrhythmia. This study aimed to evaluation ERP in Children with MVP. In a cross-sectional study, we enrolled ERP in 70 MVP children with 70 age-and sex-matched healthy individuals. After echocardiography procedure for confirmation MVP, standard 12-lead electrocardiography recordings with sweeping rate of 25mm/s and an amplitude of 10mV/cm, and two cardiologists assessed who were blinded to the both groups. We detected ERP in 17.14% of MVP patient's and seen in 8 case (11.43%) in control group, (P=0.23). the ERP occurred in MVP patient's mild, moderate and severe 4, 6 and 2 cases, (P=0.29). The ERP found in patients with and without chest pain 13 and 7, respectively (P=0.46) and, in patients with and without palpitations 15 and 5 cases, respectively (P=0.24). The ERP occurred 1.6 time more in patient with MVP in comparing with individual without MVP. The ERP occurred more frequently in among patients with moderate MVP in comparing with severe and mild. Chest pain and palpitation occurred more frequently in among patients with severe MVP. The prevalence of ERP in children with MVP has been at a higher-level incidence, especially among patients with complaining from chest pain. We suggested that children with MVP are in need of follow up considering the occurrence of arrhythmias.

Early repolarization in adolescent athletes: A gender comparison of ECG and echocardiographic characteristics.

The early repolarization pattern (ERp) is an electrocardiographic finding previously associated with arrhythmic risk in adults. The purpose of this study is to evaluate the prevalence and characteristics of ERp in a group of adolescent athletes according to gender. Furthermore, potential associations with clinical, electrocardiographic, and echocardiographic parameters are explored. In this cross-sectional study young athletes (age < 18 years) were consecutively enrolled during the annual pre-participation evaluation, undergoing also transthoracic echocardiography assessment from January 2015 to March 2020. The prevalence of ERp was 27% in the whole population. Athletes with ERp were more frequently men practicing endurance sports. Women with ERp showed lower heart rate at rest, greater posterior, and relative ventricular wall thickness than those without ERp. Men with ERp presented higher systolic blood pressure at peak exercise, greater septal wall thickness, and indexed left ventricular mass than those without ERp. Both genders with ERp showed increased QRS voltage and narrower QRS duration. The ERp phenotype in men was more frequently notched with higher amplitude and ascending ST segment. Women's ERp presented more frequently a slurred morphology, especially in the inferior leads, and horizontal ST slope. No differences emerged in the occurrence of arrhythmias at rest and during maximal exercise test between groups, even considering higher risk phenotypes. ERp is an ECG finding compatible with normal cardiac adaptations to training in young athletes. ERp demonstrated gender differences regarding phenotypes previously associated with increased cardiovascular risk, not showing any differences in arrhythmias during maximal exercise test.

Early repolarization pattern in adult females with eating disorders.

IntroductionThe risk of cardiovascular death is increased in patients with eating disorders (ED), but the background for this is unknown. Early repolarization pattern (ERP) on the electrocardiogram (ECG) has been associated with increased risk of sudden cardiac death.MethodsWe investigated the prevalence of ERP in 233 female patients with anorexia nervosa (AN) and bulimia nervosa (BN) (age 18–35 years) compared with 123 healthy female controls.ResultsEarly repolarization pattern was present in 52 (22%) of ED patients (16 (15%) AN patients and 36 (29%) BN patients) and 17 (14%) of healthy controls. When adjusting for age, BMI, heart rate, use of selective serotonin reuptake inhibitors (SSRI), and potassium level, the odds ratio (OR) for ERP was 2.1 (95% CI 1.1–4.2, p = .03). There was an increased prevalence of inferolateral ERP in patients with ED compared with healthy controls (OR = 4.3, 95% CI 1.7–11.3, p = .003) as well as ERP with a downward/horizontal sloping ST segment (OR = 3.1, 95% CI 1.3–7.6, p = .01). Additionally, J‐point elevation >0.2 mV was more prevalent in patients with ED (OR = 3.3, 95% CI 1.1–9.7, p = .03).ConclusionThe prevalence of ERP was increased in patients with ED compared with healthy controls. This finding may provide a possible explanation for the increased cardiovascular mortality in ED patients.

Worldwide prevalence of early repolarization pattern in general population and physically active individuals: A meta-analysis.

Background:The early repolarization pattern (ERP) has recently been associated with cardiac events such as ventricular arrhythmias and sudden cardiac death. However, estimates of the prevalence of ERP vary widely, especially between the general population and physically active individuals. We performed this systematic review and meta-analysis to quantitatively evaluate the worldwide prevalence of ERP in the general population and physically active individuals.Methods:We thoroughly searched the PubMed, EMBASE, Web of science, the Cochrane Library, and Scopus databases for relevant studies published until December 20, 2020. Studies in which prevalence was presented or could be estimated from eligible data were included. The pooled prevalence was analyzed using a random-effect model.Results:Finally, we included 29 studies (182,135 subjects) in the general population and 14 studies (8087 subjects) in the physically active individuals. The worldwide pooled prevalence of ERP in the general population was 11.6% (95% confidence interval [CI]: 10.0%–13.3%). The incidence of ERP was 17.0% and 6.2% in men and women, respectively. The prevalence was 20.9% in blacks, 13.4% in Asians, and 10.1% in Caucasians. Additionally, the prevalence of ERP in physically active individuals was 33.9% (95% CI: 25.3%–42.6%).Conclusion:A significant difference in the worldwide prevalence of ERP is revealed in this study. The ERP is highly prevalent in men, blacks, and physically active individuals.

Electrocardiogram in Haïssaguerre Syndrome (Early Repolarization)

Introduction: Early repolarization pattern (ERP) has traditionally been related as a benign variant of electrocardiography (ECG). However, since 2008, when two studies were published for Haïssaguerre et al. and Rosso et al., with evidence of a higher prevalence of ERP in people with primary or idiopathic ventricular fibrillation (VF), this paradigm has been challenged. Objective: To conduct a thorough review of early repolarization and current state of the art regarding risk stratification in these patients. Methods: Literature review on the subject evaluating the works published in high impact journals. Conclusion: The correlation of risk factors and the real value of the various methods currently available as possible risk stratifiers is still controversial. Advances in genetics and molecular biology may in the future help in understanding the pathophysiology and better risk stratification in this population. In this context, the standardization of the definition and classification of early repolarization is imperative, as it will serve as a substrate for future studies and researches in the area.

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

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.

Epidemiology of early repolarization pattern in an adult general population

Background: Early repolarization pattern (ERP) is a frequent finding in asymptomatic subjects with controversial implications regarding to its prognosis. This study aims to estimate the prevalence of ERP and its association with sociodemographic characteristics and cardiovascular risk factors among the adult population in the Southern Cone of Latin America.Methods: A sub-sample of 5398 participants of the CESCAS I study was included in the present analysis. ERP was defined as a J peak ≥0.1 mV in two or more contiguous leads with an end-QRS notch or slur on the downslope of a prominent R-wave.Results: The global prevalence of ERP was 8.1%; 11.1% in men and 5.6% in women. The prevalence in women increased with age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5–4.2, at >65 years, p < 0.001), current cigarette smoking (OR 1.4, 95%CI 1.0–2.0, p = 0.045) and hypercholesterolaemia (OR 1.4, 95%CI 1.0–2.0, 0 p = 0.036). Conversely, in men, ERP prevalence decreased with age (OR 0.5, 95%CI 0.3–0.9, at >65 years, p = 0.01) and obesity (OR 0.6, 95%CI 0.4–0.8, p = 0.006). We found an increasing ERP prevalence with a higher Sokolow-Lyon index in both sexes (p < 0.001). Inferior location was found in 67.9% of cases, and the most common ERP type was a “slurring” appearance without ST elevation (76.3%).Conclusions: We found an overall prevalence of ERP of 8.1% and a robust association of ERP with normal BMI and higher Sokolow-Lyon index in men and with hypercholesterolaemia, current cigarette smoking and higher Sokolow-Lyon index in women.

Impact of Ethnicity on the Prevalence of Early Repolarization Pattern in Children: Comparison Between Caucasian and African Populations

The patterns and prevalence of early repolarization pattern (ER) in pediatric populations from ethnic backgrounds other than Caucasian have not been determined. Black African children (ages 4-12) from north-west Madagascar were prospectively recruited and their ECGs compared with those of age- and sex-matched Caucasian ethnicity individuals. ER was defined by ≥ 0.1mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. A total of 616 children were included. There was a trend toward a higher frequency of ER in the Africans compared to the Caucasians (23.3% vs. 17.1%, respectively, p = 0.053). The subtype (slurred vs. notched) and location of ER (lateral, inferior, or inferior-lateral) were significantly different in the two groups (p < 0.001 and p = 0.020, respectively). There was no significant difference in the number of high-risk ECG features of ERP (i.e., horizontal/descendent pattern, inferior or inferior-lateral location or J-waves ≥ 2mm) between African and Caucasian children. On the multivariate analysis, African ethnicity was an independent predictive factor of ER (OR 3.57, 95% CI 2.04-6.25, p < 0.001). African children have an increased risk of ER compared to Caucasian counterparts. Future studies should clarify the clinical and prognostic significance of ER in the pediatric population, and whether ethnicity has an impact on the outcomes.

Clinical Significance of Early Repolarization in Long QT Syndrome

This study sought to determine the prevalence of early repolarization pattern (ERP) within a large cohort of patients with long QT syndrome (LQTS) and examine the correlation and clinical significance of ERP with symptomatic status and subsequent risk of breakthrough cardiac events (BCEs). The electrocardiographic ERP is associated with an increased risk of arrhythmic events and sudden cardiac death. ERP was defined as an end-QRS notch or slur on the downslope of a prominent R-wave with a J point≥0.1 mV in 2 or more contiguous leads of the 12-lead electrocardiogram, excluding V1 to V3. A patient was considered previously symptomatic if they had a suspected LQTS-triggered cardiac event prior to diagnosis. BCEs were defined as LQTS-attributable syncope/seizures, aborted cardiac arrest, appropriate ventricular fibrillation-terminating implantable cardioverter-defibrillator shocks, and sudden cardiac death following diagnosis and institution of a LQTS-directed treatment program. In this study, 528 patients (57% female) with genotype-confirmed LQTS (283 with LQT1, 193 with LQT2, and 52 with LQT3) were reviewed from which 2,618 electrocardiograms were analyzed over a median follow-up of 6.7 (interquartile range, 3.6 to 10 years) years. Eighty-two (15.5%; female 51%) patients were identified as having ERP; 40 (50%) of these ERP-positive patients showed persistent ERP. One hundred twenty-four patients (23.5%) were classified as previously symptomatic LQTS and 39 (7.2%) experienced a subsequent BCE. ERP was not associated with either symptomatic status (p= 0.62) or BCE (p= 0.61). Although ERP is common in LQTS, this extensive study suggests that the presence of concomitant ERPdoes not correlate with either those with a history of LQTS-triggered events prior to diagnosis or those withsubsequent BCEs from their treated LQTS substrate.

Prevalence of early repolarization pattern and its association with sudden cardiac death and arrhythmia over one-year follow-up in an Egyptian cohort.

Background and objectivesEarly repolarization pattern (ERP) is not uncommon electrocardiography (ECG) finding and could be associated with arrhythmia and sudden cardiac death (SCD). We aimed to prospectively determine the prevalence of ERP and its association with arrhythmia and SCD during one-year follow-up in an outpatient Egyptian cohort.MethodsClinical assessment and ECG were performed to 1850 consecutive individuals presented at the outpatient clinic of Suez Canal University Hospital (SCUH). Then, the ERP group and 100 age and gender-matched ERP −ve controls had undergone echocardiography, 24-h Holter ECG and exercise stress ECG.ResultsERP was found in 124 individuals (6.7%); we excluded 24 patients with structural heart disease. ERP group (No. = 100) were relatively young (80% <50 years-old) and showed male preponderance (60%). ERP frequencies were: inferolateral (50%), antero-lateral (38%), inferior (10%), and global (2%). ERP subjects were leaner than controls (BMI was 25.3 vs. 30 kg/m2, P value < 0.001) and achieved more metabolic equivalents (METS) on stress ECG (10.7 vs. 8.5 METS, P value < 0.01). Only 4% in the ERP group had horizontal/descending ST slope, while 8% had ST elevation ≥ 2 ms. No arrhythmia or SCD were reported during 1-year follow-up in both groups. Regression analysis showed that male gender, Sokolow-Lyon criteria and short QTc were significant independent predictors of ERP, P value < 0.05.ConclusionsIn outpatient-based Egyptian cohort, the prevalence of ERP was 6.7%, mostly the inferolateral pattern. Our ERP subjects had low-risk clinical and ECG criteria for malignant ERP. Further epidemiological studies are needed to explore the natural history of ERP.

Study of the influence of intensive physical exercise on the early repolarisation pattern in young military commandos

We study among the young French soldiers (who are incorporated into the army: commando corps), the influence of increasing physical exercise on the prevalence of early repolarisation pattern (ER+). This prospective, single-centre, longitudinal study was carried out over a three months period (January to April 2016). 93 commando military men from Lorient (France) were included. Men participate in intensive training (during three months). The subjects underwent a clinical examination and an initial ECG upon their recruitment, followed by a second ECG performed in the setting of a systematic follow-up at the end of the three months. The prevalence of ER+ was 11.8% (i.e. 11 subjects). The most common appearance of the J-point was as a “notch” pattern for 81.8% in the inferior leads. Three years later, there was an increase in the prevalence of the ER+ pattern, which was 30% (i.e. 26 subjects). The difference is significant ( P < 0,0001). The prevalence of the ER+ increases significantly at the end of the training period. This study assumes an association between the intensification of physical activity and the appearance of ER+.

Prevalence of early repolarisation pattern in children

BackgroundPrevalence of early repolarisation ECG pattern (ER) has been repetitively determined in adults, but has not been reported in large unselected children populations so far. MethodsECG from 1000 successive healthy children from birth to 17years old were prospectively recorded and analyzed. ER was defined by ≥0.1mV J point elevation in at least two contiguous inferior or lateral ECG leads. Correlations with age, gender, ethnic origin, physical activity, Sokolow index and heart rate were performed. ResultsPrevalence of ER pattern was 23,6% (95% CI 21–26.2%) and increased after 8years of age. ER was independently correlated to a non Caucasian origin and a higher Sokolow index, but not to gender or level of physical activity. ER was independently correlated to an older age in children with heart rate <100bpm, and to a slower heart rate in children ≥8yo. ConclusionER is present in a quarter of children of various age and is related to ethnic origin, an older age, a slower heart rate and a higher Sokolow index.

Prevalence of early repolarization pattern in patients with lone atrial fibrillation

BackgroundThe objective of this study was to test the association of early repolarization pattern (ER) with lone atrial fibrillation (AF). MethodsElectrocardiograms (ECGs) were analyzed in blinded fashion in a case–control study of 182 patients with lone AF and 182 controls without AF. ResultsPatients with lone AF and controls had similar frequencies of ER pattern (15% vs. 19%, p=0.40). In patients <50years of age, there was also no difference in the percentage of patients with ER in the AF and control groups (17% vs. 19%, p=0.60). ER pattern was more common in patients with ECG voltage criteria of left ventricular hypertrophy (LVH), with ER present in 57% of patients with elevated Sokolow-Lyon voltage compared to 14% of those without (p<0.0001). ConclusionsNo association could be identified between the ER pattern and lone AF in young and middle-aged patients. In this age group, ER is substantially more common in patients with elevated Sokolow-Lyon voltage criteria.

Early repolarization pattern in the general population: Prevalence and associated factors

ObjectivesTo evaluate the prevalence of early repolarization pattern (ERP) in the general rural Chinese population and identify the contributing risk factors. MethodsA cross-sectional study of 11,956 permanent residents of Liaoning Province ≥35y of age was conducted between January and August 2013 (response rate 85.3%). ERP was diagnosed if there was J-point elevation of ≥0.1mV in ≥2 leads in the inferior (II, III, aVF) or lateral (I, aVL, V4–6) territory, or both. Risk factors for ERP were evaluated with a stepwise logistic regression analysis. ResultsThe overall prevalence of ERP was 1.3%, and it was higher in men than women (2.6 vs. 0.2%, P<0.001), decreasing with increasing age. Percent of ERP positive in lateral leads, inferior, and both was 73.0%, 15.3%, and 11.7%, respectively. Stepwise logistic regression demonstrated that independent clinical factors for ERP included age (odds ratio [OR] 0.68; P<0.001), male sex (OR 17.09; P<0.001), systolic blood pressure (SBP) (OR 0.77; P=0.022), stroke (OR 0.14; P=0.055), RR interval (OR 1.27; P=0.001), QTc interval (OR 0.76; P=0.008), QRS duration (OR 0.67; P=0.001), Cornell voltage (OR 0.28; P<0.001), and Sokolow-Lyon voltage (OR 2.03; P<0.001). ConclusionsAlthough the prevalence of ERP in general rural Chinese population is low, younger age, male sex, lower SBP, non-stroke history, longer RR interval, shorter QTc interval, shorter QRS duration, lower Cornell voltage, and higher Sokolow-Lyon voltage are independent risk factors.

Characteristics of Early Repolarization Pattern in the Iranian Population

Background: The early repolarization pattern (ERP) has been considered a normal variant in electrocardiography (ECG) for a long time. Nevertheless, increasing evidence has demonstrated its association with adverse outcomes. Objectives: The present study aimed to evaluate the prevalence of ERP in the Iranian general population and demonstrate its clinical and ECG correlates. Methods: A cross sectional study, comprising 1424 consecutive healthy adult individuals, was conducted at two university based hospitals in Tehran, Iran in 2012-2013. The ERP prevalence, clinical characteristics and ECG morphology were investigated in volunteers. Results: ERP was present in 136 out of 1,424 people (9.6%). Slurring comprised the most frequent morphology (41.2%) followed by notching. ERP was predominantly positive in inferior leads (47.8%) followed by lateral leads (30.1%). There was also a significant male preponderance in the ERP positive group (81.6%). The mean diastolic pressure was significantly lower in the ERP positive group versus the ERP negative group (77.3 + 7.9 mmHg vs. 78.8 + 10.5 mmHg) (P = 0.03). However, despite a lower systolic blood pressure in the ERP positive subjects (120.9 + 12.6 mmHg vs. 123.1 + 14.8 mmHg), the difference was not statistically significant (P = 0.06). Conclusions: ERP was present in 9.6% of healthy Iranian individuals with a higher frequency in inferior leads and slurring as the most prevalent morphology. Additionally, there was a male preponderance and middle-aged trend for ERP.

Prevalance of early repolarization pattern in young healthy men

Background: Although the early re-polarization pattern known as a benign condition, it can result in idiopathic ventricular fibrillation and sudden cardiac death. In this study, we aimed to evaluate the prevalence of early repolarization pattern in young healthy men. Methods and Patients: Four hundred fourteen young healthy man were enrolled in the study. PR intervals, QRS durations, QT intervals and corrected QT durations were measured from electrocardiographic records. Early re-polarization pattern was defined as if an elevation J-point was greater than 0,1 mV according to the isoelectrical point. Results: The prevalence of early repolarization pattern was 23,2 % (n=96). Of these, we found early re-polarization pattern in inferior, lateral and inferolateral leads with 14,7%, 2,2% and 6,3% respectively. There was a significant relation between heart rate and elevation of J point. Conclusion: The prevalence of early repolarization pattern in young healthy men from Turkey was similar with the previously reported rates from different white populations.

16-81: Prevalence of early repolarisation in children

Introduction: Prevalence of early repolarisation pattern (ER) is 1 to 13% in adult control populations and is linked to gender, age, ethnicity and sportive activity. Prevalence and parameters of ER in children are unknown. Methods: ECG of 1000 consecutive healthy children (542 males) of various age (birth to 17 to yo) were prospectively collected and analyzed. ER was defined as > 1 mm J point elevation in at least two ECG leads in the inferior or lateral leads. Correlations with age, gender, sportive activity, ethnicity, heart rate and Sokolow index were performed. Results: Prevalence of ER pattern was 23,6% (236 children) (95% IC 21-26.2%). ER was present in 123/542 males (23%) and in 113/458 females (25%) (p = 0,4). Age was not significantky related to ER in univariate analysis, either in children > 3 years (OR 1,033/years, 95% IC 0,988-1,08, p = 0,15) or in younger children < 3 years (OR 0,989/months, 95% IC 0,958-1,022, p = 0,5). ER prevalence was not related to the heart rate. One of four asian children (25%) had ER vs 187/640 caucasians (29%) and 19/41 african children (46%) (p = 0,002). Sportive activity was not significantly related to ER in univariate analysis (OR 1,057/hour, 95% IC 0,97-1,15, p = 0,19). Sokolow index was 29,7 +/- 8,5 mm in children wit ER versus 25,9 +/- 8 mm in children without ER (p < 0,0001) (OR 1,058/mm, 95% IC 1,039-1,077, p<0,0001). In multivariate analysis, in children > 3 years, only ethnicity and a higher Sokolow index were independantly correlated to ER. Only Sokolow was linked to ER in children < 3 years. Conclusion: Prevalence of ER is 23% in children and is linked to a higher Sokolow index and to ethnicity.

57-06: Prevalence of Early Repolarization pattern in 12 lead electrocardiogram: a population based study

Background: Early Repolarization pattern (ERP) has been considered a benign finding. However, this has been recently challenged due to its association with idiopathic ventricular fibrillation. The exact prevalence and characterization in the Southern Cone of Latin America are unknown. Purpose: The main objective of the study was to determine the prevalence of ERP and its characteristics in Southern Cone of Latin America according to the last consensus (Macfarlane et al.). Methods: The study population consisted in subjects of the CESCAS I study. CESCAS I study is an observational prospective cohort study with a multistage probabilistic sample of 8000 participants aged 35–74 years from 4 cities representing the Southern Cone of Latin America designed to estimate the prevalence and distribution of and secular trends in major cardiovascular disease events and risk factors. In addition to undergoing standard resting 12-lead electrocardiography, the subjects completed a questionnaire regarding their health habits, known diseases, and medications. Biochemical and physical parameters were measured by a trained nurse. For the present analysis we use 5940 ECGs from 3 cities, we excluded 300 subjects for whom ECGs were missing or incomplete. We also excluded 242 subjects with bundle branch block, Wolf–Parkinson–White pattern, atrial fibrillation, and cardiac pacing. Two trained cardiologists, blinded to clinical data, independently assessed all ECGs and recorded the presence of ERP. A third cardiologist judged the disagreements. Interobserver reliability was evaluated. Results: A total of 5398 ECGs were analysed with a male proportion of 41.3% and a mean age of 54.3 ± 10.7 years. The inferior location was found in 67.94% of cases (267/5398). The most common type was the “slurring” appearance without ST elevation represented 76.34% of cases. There was an important strength of agreement between the two initial interpreters (k= 0.89, proportion agreement 86.46%). In the multivariable regression model independent predictors of ERP were body mass index (OR 0.97 95% CI 0.95; 0.99), male sex (OR 1.47 95% CI 1.19; 1.81) and Sokolov Index (OR 1.04 95% CI 1.02; 1.06), p vale < 0.01. Conclusions: Consistent with published estimates ranging from 1% to 13% we found an overall prevalence of ERP of 8.1%. Male sex, lower body mass index and lower Sokolov Index were independently associated with the presence of ERP. Figure 1. Weighted prevalence of ERP by age and gender.

Electrocardiographic Early Repolarization: A Scientific Statement From the American Heart Association.

The early repolarization (ER) pattern (ERP), initially described as elevation of the ST segment of ≥1 leads on the 12-lead ECG, has long been considered a benign phenomenon. However, more recent studies have demonstrated positive, negative, and neutral associations between an ERP and various end points, including all-cause, cardiac, and arrhythmic mortality. These recent studies have used more complex or heterogeneous definitions of ER, including J-wave or J-point elevation and QRS complex notching or slurring, with or without concomitant ST-segment elevation. Other studies have identified an increased prevalence of ERP in survivors of spontaneous ventricular fibrillation (VF) or cardiac arrest. As a result, considerable confusion remains concerning the definition of ERP, its prognostic significance, and whether additional evaluation or treatment is warranted. These issues are especially important because the prevalence of ERP may be as high as 10% in the general population and even higher in some healthy subgroups. The writing group performed a comprehensive literature search and developed recommendations based on the results of the current literature. We searched MEDLINE (via PubMed), EMBASE, and the Cochrane Library to identify relevant primary scientific articles, guideline statements, and review articles in the literature. Search terms included, but were not limited to, early repolarization, J-point elevation, J wave, Haissaguerre syndrome, sudden cardiac death, idiopathic ventricular fibrillation, ventricular fibrillation, cardiac repolarization reserve, sudden unexplained death syndrome, and Osborn waves. We also reviewed the references of highly cited documents and citing documents. The recommendations were voted on, and 80% agreement was required for inclusion. The purposes of this document are as follows:

Early repolarization pattern: a marker of increased risk in patients with catecholaminergic polymorphic ventricular tachycardia.

The early repolarization pattern (ERP) has been shown to be associated with arrhythmias in patients with short QT syndrome, Brugada syndrome, and ischaemic heart disease. Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome and related to malignant ventricular tachyarrhythmias in a structurally normal heart. The aim of this study was to evaluate the prevalence of ERP and clinical events in patients with CPVT. Digitalized resting 12-lead ECGs of patients were analysed for ERP and for repolarization markers (QT and Tpeak-Tend interval). The ERP was diagnosed as 'notching' or 'slurring' at the terminal portion of QRS with ≥0.1 mV elevation in at least two consecutive inferior (II, III, aVF) and/or lateral leads (V4-V6, I, aVL). Among 51 CPVT patients (mean age 36 ± 15 years, 11 males), the ERP was present in 23 (45%): strictly in the inferior leads in 9 (18%) patients, in the lateral leads in 9 (18%) patients, and in infero-lateral leads in 5 (10%) patients. All patients with ERP were symptomatic at presentation (23 of 23 patients with ERP vs. 19 of 28 patients without ERP, P = 0.003). Syncope was also more frequent in patients with ERP (18 of 23 patients with ERP vs. 11 of 28 patients without ERP, P = 0.005). A pathologic ERP is present in an unexpected large proportion (45%) of patients and is associated with an increased frequency of syncope. In patients with unexplained syncope and ERP at baseline, exercise testing should be performed to detect CPVT.