Early repolarization syndrome – inferolateral vs anterolateral: malignant vs benign?

Early repolarization syndrome – inferolateral vs anterolateral: malignant vs benign?

Early repolarization syndrome: malignant vs benign? Early repolarization syndrome or pattern in the ECG (electrocardiogram) has been thought to be a benign normal variant pattern for a long time. But some recent articles have linked it with idiopathic ventricular fibrillation.¹ Others have found it to be linked with cardiac channelopathies like Brugada syndrome with a malignant course.²

It has been proposed that the early repolarization pattern if found in inferolateral leads have a more sinister connotation than in the classical anterolateral leads. The J wave is thought to have more malignant nature than the classical concave upwards ST segment elevation of early repolarization syndrome. The J wave itself has been described as two types – one as a slurring of the terminal QRS in the region of J point with smooth transition to the ST segment and another with a notch of positive spike at the end of the QRS.

It may be noted that anterior upsloping ST segment elevation can be present without the early repolarization, which is now recognized to be a normal pattern in young males. Recognition of this fact has even resulted in revision of criteria for diagnosis of ST elevation myocardial infarction where more ST segment elevation is required in anterior leads than other leads.

References

1. Haissaguerre M et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008;358:2016-23.
2. Kawata H et al. Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: a novel risk factor for Brugada syndrome with ventricular fibrillation. Heart Rhythm;10:1161-8.