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Long-term outcome associated with early repolarization on electrocardiography
Jani T Tikkanen1, Olli Anttonen, M Juhani Junttila
1Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
The New England Journal of Medicine
|November 18, 2009
Summary
Early repolarization on electrocardiograms, particularly in inferior leads, is linked to a higher risk of cardiac death in middle-aged individuals. This finding highlights the prognostic significance of this common ECG pattern in the general population.
Area of Science:
- Cardiology
- Electrocardiography
- Public Health
Background:
- Early repolarization (ER) on 12-lead electrocardiography (ECG) is defined by J-point elevation in leads excluding V1-V3.
- While ER is linked to ventricular fibrillation vulnerability, its prognostic value in the general population is not well understood.
Purpose of the Study:
- To determine the prevalence and prognostic significance of early repolarization in a community-based, middle-aged population.
- To assess the association between ER patterns and cardiac mortality, all-cause mortality, and arrhythmia-related death.
Main Methods:
- A community-based cohort of 10,864 middle-aged subjects underwent 12-lead ECG.
- Early repolarization was categorized by J-point elevation (> or = 0.1 mV or > 0.2 mV) in inferior or lateral leads.
- Follow-up averaged 30 years, with cardiac death as the primary endpoint.
Main Results:
- The early repolarization pattern (J-point elevation >= 0.1 mV) was found in 5.8% of subjects.
- ER in inferior leads (>= 0.1 mV) correlated with increased cardiac death risk (aRR, 1.28).
- Significant J-point elevation (> 0.2 mV) in inferior leads markedly increased cardiac death (aRR, 2.98) and arrhythmia death (aRR, 2.92) risk.
Conclusions:
- An early repolarization pattern in the inferior leads of a standard ECG is associated with an elevated risk of cardiac death.
- This ECG finding holds prognostic significance for cardiac events in middle-aged individuals.
- Inferior lead ER is a notable risk marker in the general population.
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