Clinical Implication of Early Repolarization
Abstract
Early repolarization described as J-point elevation with concaved
ST segment, notch or slurred at terminal QRS complex on surface
electrokardiography. This electrokardiography pattern that usually exists
in young male population, for about 60 years has been concluded as
benign normal variant electrokardiography. Klatsky in 2002, has strengthed
this issues with his study with 1000 elecrokardiographies with early
repolarization which were followed for 12 years. There was no significant
case for hospitality or malignant ventricular arrhythmias among population
with early repolarization comparared with normal elektrokardiography
without early repolarization.
But, recent studies with larger samples, show different thing, which is there
was a correlation between early repolarization and malignat ventricular
arrhythmias. So the issue is, whether we can still consider this early
repolarization as a normal variant or not. And how about the management
of asymptomatic population with early repolarization such as syncope or
evidence of malignant ventricular arrhythmias.
T-wave Alternans is a difference at amplitude or morphology of ST segment
and T wave in every other heart beat. T-wave Alternans measurement is a
non-invasive method to value cardiac cells hererogeneity. This examination
has been proven to be useful as a risk stratification for malignant ventricular
arrhythmias events in large studies. Higher T-wave Alternans value
accompanied with higher risk for developing these arrythymias. T-wave
Alternans measurement has been approved in the guideline for management
of wide QRS complex tachyarrythmias for detection ventricular arrhythmias
with I and IIa class of recommedantion. The more practical Modified Moving
Average technicque which can be performed in healthy subjects with early
repolarization is useful for risk stratification. Large studies have approved
the use of Modified Moving Average for measure T-wave Alternans in these
arrhythmias risk stratification.
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