Early Repolarization Pattern in Competitive Athletes: Clinical Correlates and the Effects of Exercise Training

Study Questions:

What are the correlates of nonanterior early repolarization pattern in competitive athletes?


Early repolarization pattern was assessed in a cross-sectional cohort of collegiate athletes (n = 879). The relationship between early repolarization pattern and cardiac structure then was examined in a longitudinal subgroup (n = 146) before and after a 90-day period of exercise training. Early repolarization pattern was defined as J-point elevation ≥0.1 mV in at least two leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]).


Nonanterior early repolarization pattern was present in 25.1% (221 of 879) of athletes, including the inferior subtype in 3.8% (33 of 879). Exercise training led to significant increases in the prevalence of early repolarization pattern and the inferior subtype of early repolarization, but there were no associations between early repolarization pattern and echocardiographic measures of left ventricular remodeling. In a multivariable model, early repolarization pattern was associated with black race (odds ratio [OR], 5.84; 95% confidence interval [CI], 3.54-9.61; p < 0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71-2.52; p < 0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26-1.87; p < 0.001).


The authors concluded that nonanterior early repolarization pattern, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased early repolarization pattern prevalence after intense physical training establishes a strong association between exercise and early repolarization pattern.


Approximately 2-5% of the population demonstrates a pattern of early repolarization on ECG; seen most commonly in men, young adults, athletes, and Blacks. Although thought for many years to be a benign variant, early repolarization involving the inferior leads has been associated with an increased risk of sudden cardiac death. This study found that nonanterior early repolarization (including inferior early repolarization associated with sudden cardiac death risk) was very common among athletes (25%) and increased in prevalence in association with intense exercise training. However, it would be controversial to suggest that exercise training increases the risk of sudden cardiac death when physical fitness is known to dramatically decrease overall cardiovascular risk.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Sports and Exercise Cardiology, Implantable Devices, Echocardiography/Ultrasound, Sports and Exercise and Imaging

Keywords: Athletes, Physical Fitness, Sports, Risk Factors, Electrocardiography, Heart Rate, Prevalence, Death, Ventricular Remodeling, Cardiovascular Diseases, Bradycardia, Echocardiography

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