Early repolarization: benign or lethal?

Early repolarization: benign or lethal?

Early repolarization: benign or lethal? Early repolarization has been hitherto considered as benign ECG change, till a couple of studies published in 2008 in leading journals caught the attention of the cardiovascular fraternity.

Haissaguerre et al, [N Engl J Med 2008;358:2016–23] reported that sudden cardiac arrest was associated with early repolarization pattern on the electrocardiogram. In another study Rosso et al, [J Am Coll Cardiol 2008;52:1231– 8] noted J-point elevation in survivors of ventricular fibrillation.

Long term outcome of early repolarization syndrome was evaluated by Tikkanen et al [N Engl J Med 2009;361:2529 –37] in a study involving 10864 subjects from Finland. J point elevation 0.1mV or more was observed in 630 persons in ECGs obtained between 1966 – 1972. The follow up period was 30 +/- 11 years. J-point elevation in inferior leads was associated with males, smokers, those with lower resting heart rate and blood pressure, those with lower body mass index, shorter QTc, longer QRS duration and ECG evidence of coronary artery disease. In those with J-point elevation of 0.1mV or more in the inferior leads, before and after multivariate adjustment, there was higher risk of cardiac death and higher risk of arrhythmic death. But the all cause mortality was not significantly higher. In those with more than 0.2mV J-point elevation in inferior leads, there was higher risk of cardiac death, higher risk of arrhythmic death and all cause mortality.
J-point elevation in lateral leads was associated with left ventricular hypertrophy and higher arrhythmic death. Prediction of cardiac and all cause death was only of borderline significance.
Though it is apparent that J-point elevation in inferior leads confers a higher risk, more research is definitely needed to clarify this issue further.