J wave elevation to monitor quinidine efficacy in early repolarization syndrome

We present the case of a 14-year-old female with early repolarization syndrome who presented with recurrent ventricular fibrillation and ICD shocks which were refractory to multiple drugs and catheter ablation. Treatment with quinidine, an Ito blocker, resulted in a normalization of J waves and suppression of VF. Interestingly, J wave amplitude correlated with the ventricular arrhythmia susceptibility and quinidine levels. The case highlights the importance of quinidine for management of ventricular arrhythmias in the context of early repolarisation and suggests that J wave amplitude may be an important indicator of therapeutic drug levels and arrhythmia susceptibility.