Early repolarization and sudden cardiac arrest: theme or variation on a theme?

The association between early repolarization patterns on electrocardiograms and risk of idiopathic ventricular fibrillation reported by Haïssaguerre et al. raises questions about the generally held concept that early repolarization is a benign electrocardiographic pattern. Although the association reported is strong enough to suggest validity, the data do not permit distinction between the following two possibilities: that early repolarization is a single pathophysiological entity with variable expression, or that early repolarization is a nonspecific electrocardiographic pattern that might be associated with specific high-risk or low-risk entities. Until prospective population data are available, physicians should continue to view this common electrocardiographic variant as generally benign. Careful attention should, however, be paid to patients with early repolarization and J-point elevations of more than 2 mm, especially those with otherwise unexplained arrhythmias or a family history of unexplained sudden death.