Electrocardiographic Early Repolarization: AHA Statement

Patton KK, Ellinor PT, Ezekowitz M, et al.
Electrocardiographic Early Repolarization: A Scientific Statement From the American Heart Association. Circulation 2016;Mar 7:[Epub ahead of print].

The following are 10 points to remember from this review of early repolarization (ER):

  1. There has not been a standardized definition of ER, and the authors of this document recommend that the term “early repolarization pattern” (ERP) be used to refer either to ST-segment elevation in the absence of chest pain, terminal QRS slur, or terminal QRS notch.
  2. Early repolarization syndrome (ERS) refers to patients with ERP who have survived idiopathic ventricular fibrillation (VF).
  3. A prevalent explanation for ERP is regional heterogeneity in the dispersion gradient of myocardial refractoriness, prompted by a net outward shift in repolarizing current and predisposing to phase 2 reentry, allowing a premature ventricular depolarization to trigger VF.
  4. The genetic basis of ERP is unclear and it is possible that there are various genetic forms of ERP, some of which predispose to ERS.
  5. ER is present in approximately 20% of individuals and is more prevalent among men, blacks, individuals <40 years of age, and athletes.
  6. Available data suggest that ERP in a young adult increases the risk of idiopathic VF from 3.4/100,000 to 11/100,000.
  7. The contour of the ST segment has prognostic value, with J point elevation and a rapidly ascending ST segment being a benign finding, whereas J point elevation followed by a horizontal or descending ST segment is associated with idiopathic VF.
  8. Because the risk of VF in an asymptomatic young adult with ER is estimated to be only 1/3,000 even when the ST segment is horizontal, the ST segment morphology is not useful for clinical decision making unless the individual has had loss of consciousness compatible with cardiac syncope.
  9. Evaluation of asymptomatic individuals with ERP is not recommended.
  10. Programmed ventricular stimulation is not recommended in patients with aborted sudden death when the only electrocardiographic finding is ERP.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Sports and Exercise Cardiology, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, CHD & Pediatrics and Arrhythmias, Sports & Exercise and Congenital Heart Disease & Pediatric Cardiology

Keywords: Arrhythmias, Cardiac, Athletes, Brugada Syndrome, Chest Pain, Death, Sudden, Electrocardiography, Syncope, Unconsciousness, Ventricular Fibrillation, Young Adult

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