Role of Electrophysiological Studies in Predicting Risk of Ventricular Arrhythmia in Early Repolarization Syndrome | Journal Scan

Study Questions:

Is there a role for electrophysiologic study (EPS) in patients with early repolarization (ER) syndrome presenting with aborted sudden death?


From an international registry of idiopathic ventricular fibrillation (VF), the study group consisted of 81 patients with ER syndrome who underwent EPS (two ventricular sites, with up to three extrastimuli) after they were resuscitated from a cardiac arrest. Structural heart disease was excluded in all. Brugada syndrome, long/short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and patients >60 years of age were excluded. ER syndrome was defined as ≥0.1 mV of J-point elevation in the inferior or lateral leads, with notching of the S wave or slurring of the QRS complex, history of cardiac arrest, and absence of structural heart disease. All patients underwent implantation of an implantable cardioverter-defibrillator (ICD).


VF was inducible in 18 patients (22%). Twenty-seven (mean age, 36 years) of the 81 patients (33%) experienced appropriate shocks during a follow-up period of 7 years. Six of the 18 (33%) patients with inducible VF experienced appropriate ICD shocks, as compared to 21 of 63 patients (33%) without inducible VF. VF inducibility was not related to various electrocardiographic (ECG) parameters that have been shown to be associated with adverse outcomes in patients with ER syndrome.


The authors concluded that VF inducibility does not help identify patients who are likely to experience ICD shocks for recurrent ventricular arrhythmias in patients with ER syndrome.


Until recently, the ER pattern on ECG was considered to be a benign variant. However, in some, it may be associated with sudden death due to VF. Since the variant is relatively common, various ECG parameters have been promulgated to help identify individuals at high risk. The role of EPS in patients with an ER pattern is unknown. Based on the results of this study, EPS is unlikely to be helpful in the management, for example, of a patient with ER pattern and unexplained syncope. In such a situation, an ICD may be considered.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Brugada Syndrome, Death, Sudden, Defibrillators, Implantable, Electrocardiography, Heart Arrest, Syncope, Tachycardia, Ventricular

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