Early Repolarisation - What Should the Clinician Do?

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Early repolarization (ER) is a frequent electrocardiogram (ECG) finding with generally low risk.
• In some cases, ER is associated with increased risk of arrhythmias, particularly in the presence of underlying cardiac pathology.
• Rarely, ER syndrome can be a primary cause of life-threatening ventricular fibrillation (VF).

Purpose of the Study:

• To review the clinical significance of the early repolarization (ER) pattern on ECG.
• To discuss the definition and presentation of ER syndrome.
• To highlight the need for risk stratification tools in asymptomatic individuals with ER.

Main Methods:

• Systematic review of literature concerning early repolarization (ER) and ER syndrome.
• Analysis of ECG features associated with increased arrhythmic risk.
• Discussion of current clinical approaches to risk stratification and management.

Main Results:

• Most individuals with ER have minimal risk for arrhythmic events.
• ER syndrome is defined by syncope or cardiac arrest attributed to ventricular arrhythmias in the context of ER, after excluding other causes.
• Certain ECG characteristics may indicate a higher risk, but validated risk-stratifying tools are lacking.
• Asymptomatic patients without a family history of malignant ER can generally be reassured.

Conclusions:

• Management of ER involves addressing modifiable cardiac risk factors in all patients.
• Symptomatic patients require systematic investigation guided by their specific symptoms.
• Further research is needed to develop clinically useful tools for identifying high-risk asymptomatic individuals with ER.