From the Guidelines
Early repolarization is a common electrocardiogram (ECG) finding characterized by a distinct J point and ST elevation in the lateral or inferolateral leads, occurring in approximately 1% to 13% of the general population, particularly in young athletes, especially African American males 1. This pattern is generally considered a benign normal variant, but it has been associated with an increased risk of cardiac death in population-based studies 1. The early repolarization pattern is more prevalent in young athletes, with 70% of the subjects being male, and it occurs in 15% to 70% of idiopathic VF cases 1. Some key characteristics of early repolarization include:
- A distinct J point and ST elevation in the lateral or inferolateral leads
- More prevalent in young athletes, particularly African Americans
- Occurs in 1% to 13% of the general population and in 15% to 70% of idiopathic VF cases
- Associated with an increased risk of cardiac death in population-based studies 1 However, it's essential to note that the absolute risk in patients with early repolarization remains low, and the clinical significance of the early repolarization pattern in patients with syncope is unknown 1. In clinical practice, no specific treatment is required for asymptomatic individuals with early repolarization, as it's considered a normal variant rather than a pathological condition. Nevertheless, further cardiac evaluation may be warranted if a patient with early repolarization experiences syncope, palpitations, or has a family history of sudden cardiac death 1.
From the Research
Definition of Early Repolarization
- Early repolarization is an electrocardiographic sign characterized by an elevation of the J point and/or ST segment from the baseline by at least 0.1 mV in at least two adjoining leads 2, 3, 4.
- It is also known as early repolarization syndrome (ERS) when associated with a high risk of life-threatening arrhythmias and sudden cardiac death (SCD) 2, 5, 3.
Characteristics and Risk Factors
- Early repolarization characteristics associated with a high risk of arrhythmic death include high-amplitude J-point elevation, horizontal/descending ST segment, and inferior lead location 2, 3.
- The prevalence of ERS varies between 3% and 24%, depending on age, sex, and J-point elevation 3.
- ERS patients are at a higher risk of having recurrent cardiac events, while asymptomatic individuals with early repolarization are common and have a good prognosis 2, 3.
Clinical Implications and Treatment
- ERS is a rare but increasingly recognized cause of malignant ventricular arrhythmias 5.
- Implantable cardioverter-defibrillator (ICD) implantation and quinidine are recommended treatments for ERS patients 2, 5.
- Risk stratification in asymptomatic patients with ERS remains a grey area, and further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS 3.
- Clinical and electrocardiographic data are essential for differential diagnosis, as several clinical entities can cause ST-segment elevation 4.