Distinguishing "benign" from "malignant early repolarization": the value of the ST-segment morphology
Raphael Rosso1, Eran Glikson, Bernard Belhassen
1Department of Cardiology, Tel Aviv Sourasky Medical Center and, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Identifying malignant early repolarization is crucial. Combining J waves with a horizontal ST segment significantly improves the diagnosis of idiopathic ventricular fibrillation (VF), offering a more reliable indicator than J waves alone.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Distinguishing benign early repolarization from malignant forms is clinically important.
- Horizontal ST segments in early repolarization predict arrhythmic death.
- The study investigates the diagnostic value of combining J waves and ST segment morphology for idiopathic ventricular fibrillation (VF).
Purpose of the Study:
- To assess if ST segment morphology enhances the diagnostic accuracy of J waves for idiopathic VF.
- To differentiate between benign and malignant early repolarization patterns.
Main Methods:
- Reanalysis of a case-control study involving 45 idiopathic VF patients and controls.
- Focus on patients with J waves, categorizing ST segment morphology as horizontal or ascending.
- Comparison of J waves alone versus combined J waves and horizontal ST segments for idiopathic VF prediction.
Main Results:
- J waves alone correlated with idiopathic VF (OR=4.0).
- The combination of J waves and horizontal ST segments showed a significantly higher odds ratio for idiopathic VF (OR=13.8).
- This combined pattern improved the distinction between idiopathic VF patients and controls.
Conclusions:
- The combination of J waves and horizontal/descending ST segments is a valuable tool for identifying idiopathic VF.
- This ECG finding improves the ability to distinguish patients with idiopathic VF from controls.
- Further research may refine diagnostic criteria for early repolarization syndromes.
Background:
Means for distinguishing the very common "benign early repolarization" from the very rare but malignant form are needed. Recently, the presence of early repolarization with "horizontal ST segment" was found to predict arrhythmic death during long-term follow-up in a large population study. We therefore speculated that the combination of "J waves with horizontal ST segment" would correlate with a history of idiopathic ventricular fibrillation (VF) better than the mere presence of J waves.
Objectives:
To determine whether the morphology of the ST segment adds diagnostic value to the mere presence of J waves in a case-control series of idiopathic VF.
Methods:
We reanalyzed our case-control study showing that the presence of J waves strongly correlates with a history of idiopathic VF among 45 patients with this disorder, 124 controls matched for age and gender ("matched-control" group), and 121 young athletes. This time we focused only on those patients with J waves and graded their ST-segment morphology as either "horizontal" or "ascending" according to predefined criteria.
Results:
The presence of J waves was associated with a history of idiopathic VF with an odds ratio of 4.0 (95% confidence intervals = 2.0-7.9), but having both J waves and horizontal ST segment yielded an odds ratio of 13.8 (95% confidence intervals = 5.1-37.2) for having idiopathic VF.
Conclusions:
We report, for the first time, that the combination of J waves with horizontal/descending ST segment improved our ability to distinguish patients with idiopathic VF from controls matched by gender and age.
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