Early repolarization

Dimitrios D. Manolatos, MD, PhD, FESC

Second Department of CardiologyEvangelismos General Hospital of Athens

Athens, Greece

WHATS THE NEXT STEP

•EP STUDY

•LOOP RECORDER

•TILTING TEST

•DISCHARGE

Definition of early repolarization

J-point ≥ 1mm (notching vs. slurring) in two contiguousleads (lateral or inferolateral) with or withoutconcomitant ST-segment elevation

N Engl J Med. 2008 May 8;358(19):2016-23

N Engl J Med. 2008 May 8;358(19):2016-23

N Engl J Med. 2008 May 8;358(19):2016-23

N Engl J Med. 2008 May 8;358(19):2016-23

Journal of Arrhythmia 2016;32:315–339

fragmentation

J Am Coll Cardiol 2015;66:470–7

Rapidly ascending (A) and horizontal (B) ST segment in the leads

deploying J waves (arrows).

Heart Rhythm 2011

Heart Rhythm 2016;13:894–902

Regression analysis demonstrated that QTc

interval (odds ratio [OR] per 10 ms: 1.15,

95% confidence interval [CI} 1.02–1.30),

maximal J-wave amplitude (OR per 0.1 mV:

1.68, 95% CI 1.23–2.31), lower T/R ratio

(OR per 0.1 unit: 0.62, 95% CI 0.47–0.81),

presence of low-amplitude T waves (OR 3.53,

95% CI 1.26–9.88). and presence of J waves

in the inferior leads (OR 2.58, 95% CI 1.18–

5.65) were associated with malignant ER.

Distinguishing malignant from benign J-waves

“Malignant”

ER

“Benign”

ER

Clinical data

Gender (males) +++ -

Syncope without prodromes +++ -

Syncope with prodromes - +++

Syncope at rest/seizures at

night

++ -

Aborted SCD ++++ -

Family history of SCD ++ -

Family history of BrS + -

Distinguishing malignant from benign J-waves

“Malignant” ER “Benign” ER

ECG criteria

J-point amplitude > 2 mm ++++ -

J-point amplitude > 1 mm ++ -

Notched J-point (J-wave) ++ -

Slurred J-point + -

Inferior ER ++ -

Lateral ER - +

Inferolateral ER +++ -

Global ER ++++ -

Ascending ST-segment - ++

Descending ST-segment +++ -

Low amplitude T-waves V5-6 +++ -

International Journal of Cardiology 2007;114:390-392

Early repolarization associated with ventricular fibrillation

N Engl J Med. 2008 May 8;358(19):2016-23

Journal of Arrhythmia 2016;32:315–339

Early repolarization associated with VF:

Increased J-point amplitude before VF

Europace 2013; 15:1389–1406

RARELY

WILL NOT