Early repolarization variant in syncopal patients referred to tilt testing

Area of Science:

• Cardiology
• Electrocardiography
• Clinical Electrophysiology

Background:

• Early repolarization variant (ERV) is an electrocardiogram (ECG) pattern linked to sudden cardiac death (SCD) risk in some groups.
• The clinical significance of ERV in patients experiencing syncope due to suspected reflex syncope requires investigation.

Purpose of the Study:

• To determine the prevalence and significance of ERV in patients undergoing tilt testing for suspected reflex syncope.
• To assess the association between ERV, J-point elevation, and tilt testing outcomes.

Main Methods:

• 160 patients with syncopal episodes underwent ECG and tilt testing.
• ERV was defined by J-point elevation (≥ 0.1 mV) in specific ECG leads.
• Patients were followed for 2 years.

Main Results:

• ERV was identified in 31% of patients, predominantly the ascending ST elevation type in lateral leads.
• Male sex was associated with a higher likelihood of ERV (OR=2.84).
• ERV in inferior leads correlated with a higher risk of positive tilt testing (OR=3.57).

Conclusions:

• Ascending ST elevation ERV is common in middle-aged individuals with suspected reflex syncope.
• ERV was frequent and associated with positive tilt testing in this cohort.
• Longer follow-up is necessary to establish the clinical importance of ERV in reflex syncope patients given its potential link to SCD.