Early Repolarization Is Not Always Benign
Abstract
Early repolarization (ER) pattern is marked with J-point elevation, slurring or notching the terminal portion of the QRS and ST segment elevation has been considered benign over the last few decades. However, some reports now suggest a link between early repolarization and increased risk of death due to arrhythmias and idiopathic ventricular fibrillation (VF), known as ER syndrome. Implantable cardioverter-defibrillators implantation and drug isoproterenol are the suggested therapy in patients with ER syndrome. In contrast, patients without symptoms of the syndrome ER are common and have a better prognosis. Risk stratification in asymptomatic patients in the ER remains a gray area. There are still many unanswered questions, so studies exploring the underlying mechanisms of ER continues to be developed.Downloads
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References
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26. Haissaguerre M. Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. J Am Coll Cardiol. 2009;53(7):612-9.
27. Mahida S, Derval N, Sacher F. Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome. J Am Coll Cardiol. 2015; 65:151.
28. Fletcher G, Ades P, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: A scientific statement from the American Heart Association. Circulation. 2013;128:873-934.
29. Haissaguerre M, Sacher F, Nogami A, Komiya N, Bernard A, Probst V. Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. J Am Coll Cardiol. 2009;53:612-9.
2. Grant R, Estes H, Doyle J. Spatial vector electrocardiography; the clinical characteristics of S-T and T vectors. Circulation. 1951;3:182-97.
3. Miyazaki S, Shah A, Haissaguere M. Early repolarization syndrome: a new electrical disorder associated with sudden cardiac death. Circulation. 2010;74:2039-44.
4. Klatsky A, Oehm R, Cooper R. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med. 2003;115:171.
5. Priori SG, Wilde A, Horie M, Cho Y, Behr ER, Berul C, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10:1932.
6. Patton K, Ellinor P, Ezekowitz M. Electrocardiographic Early Repolarization: A Scientific Statement From the American Heart Association. Circulation. 2016;133:1520.
7. Macfarlane P, Antzelevitch C, Haissaguerre M, Huikuri HV,Potse M, Rosso R, et al. The Early Repolarization Pattern. Am Coll Cardiol. 2015;66:470-7.
8. Antzelevitch C, Yan G. J wave syndromes. Heart Rhythm. 2010;7:549-58.
9. Derval N, Simpson C, Birnie B, Healey J, Chauhan V, Champagne J, et al. Prevalence and characteristics of early repolarization in the CASPER registry: cardiac arrest survivors with preserved ejection fraction registry. J Am Coll Cardiol. 2011;58:722-8.
10. Haïssaguerre M, Derval N, Sacher F. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358:2016.
11. Rosso R, Kogan E, Belhassen B, Rozovski U, MMScheinman, Zeltser D. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol. 2008;52:1231-8.
12. Sinner M, Reinhard W, Muller M, Beckmann B, Martens E, Perz S. Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PloS Med. 2010;7:123-4.
13. Cappato R, Furlanello F, Giovinazzo V, Infusino T, Lupo P, Pittalis M. J wave, QRS slurring, and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker of risk or innocent bystander? Circ Arrhythm Electrophysiol. 2010;3:305-11.
14. Yan G, Wu, Liu T. Cellular basis for the early repolarization syndrome: a comparison with the Brugada syndrome (abstr). Pacing Clin Electrophysiol. 2000;23(Suppl.II):18.
15. Noseworthy P, Tikkanen J, KPorthan, LOikarinen, APietila, Harald K, et al. The early repolarization pattern in the general population: clinical correlates and heritability . J Am Coll Cardiol 2011;57:2284-9.
16. Antzelevitch C, Yan G. Genetic, molecular and cellular mechanisms underlying the J-wave syndromes. Circulation. 2012;76:1054-65.
17. Krishnan S, Antzelevitch C. Flecainide-induced arrhythmia in canine ventricular epicardium. Phase 2 reentry? Circulation. 1993;87:562-72.
18. Benito B, Guasch E, Rivard L, Nattel S. Clinical and mechanistic issues in early repolarization of normal variants and lethal arrhythmia syndromes. J Am Coll Cardiol. 2010;56:1177-86.
19. Reinhard W, Kaess B, Debiec R. Heritability of early repolarization: A population-based study. Circ Cardiovasc Genet. 2011;4:134-8.
20. Haissaguerre M, Chatel S, Sacher F. Ventricular fibrillation with prominent early repolarization associated with a rare variant of KCNJ8/KATP channel. J Cardiovasc Electrophysiol. 2009 20:93-8.
21. Medeiros-Domingo A, Tan B, Crotti L. Gain-offunction mutation S422L in the KCNJ8-encoded cardiac KATP channel Kir6.1 as a pathogenic substrate for J-wave syndromes. Heart Rhythm. 2010;7:1466-71.
22. Burashnikov E, Pfeiffer R, Barajas-Martinez H. Mutations in the cardiac L-type calcium channel associated with inherited J-wave syndromes and sudden cardiac death. Heart Rhythm. 2010;7:1872-82.
23. Tikkanen J, Anttonen O, Junttila M, Aro A, Kerola T, Rissanen H, et al. Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med. 2009;361:2529-37.
24. Roten L, Derval N, Sacher F, Pascale P, Wilton S, Scherr D, et al. Ajmaline attenuates electrocardiogram characteristics of inferolateral early repolarization. Heart Rhythm. 2012;2:232-9.
25. Bastiaenen R, Raju H, Sharma S, Papadakis M, Chandra N, Muggenthaler M, et al. Characterization of early repolarization during ajmaline provocation and exercise tolerance testing. Heart Rhythm. 2013;2:247-54.
26. Haissaguerre M. Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. J Am Coll Cardiol. 2009;53(7):612-9.
27. Mahida S, Derval N, Sacher F. Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome. J Am Coll Cardiol. 2015; 65:151.
28. Fletcher G, Ades P, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: A scientific statement from the American Heart Association. Circulation. 2013;128:873-934.
29. Haissaguerre M, Sacher F, Nogami A, Komiya N, Bernard A, Probst V. Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. J Am Coll Cardiol. 2009;53:612-9.
Published
2017-04-18
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How to Cite
Fatullah, I., & El Rasyid, H. (2017). Early Repolarization Is Not Always Benign. Indonesian Journal of Cardiology, 37(2), 98-106. https://doi.org/10.30701/ijc.v37i2.572
Section
Review Article
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