Early repolarization syndrome (ERPS)

ECG Quiz 17

Early repolarization syndrome (ERPS) Early repolarization syndrome (ERPS)

This ECG shows early repolarization syndrome, as evidenced by the concave upwards ST segment elevation in leads V2 to V6. A closely similar pattern can occur in hyperacute phase of myocardial infarction. Moreover, persons with ERPS can also develop myocardial infarction. So if the clinical history is suggestive of ischemic cardiac pain, it is better to follow up with serial ECGs and cardiac troponin estimations. The ECG pattern of ERPS can be abolished by exercise or atropine which increases the heart rate. But these methods are not to be adopted in a person with suspected acute coronary syndrome, for obvious reasons.

Conventionally, ERPS is considered a benign condition, mostly confusing the diagnosis of ST elevation myocardial infarction. A study published in NEJM by Haïssaguerre M et al has described an association between sudden cardiac arrest and ERPS [1].

Reference

  1. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, Pasquié JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C, Scanu P, Mabo P, Matsuo S, Probst V, Le Scouarnec S, Defaye P, Schlaepfer J, Rostock T, Lacroix D, Lamaison D, Lavergne T, Aizawa Y, Englund A, Anselme F, O’Neill M, Hocini M, Lim KT, Knecht S, Veenhuyzen GD, Bordachar P, Chauvin M, Jais P, Coureau G, Chene G, Klein GJ, Clémenty J. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008 May 8;358(19):2016-23.