Early Repolarisation Changes in ECG: Are they Benign or Malignant?

Area of Science:

• Cardiology
• Electrophysiology
• Medical Diagnostics

Background:

• Early repolarisation (ER) is an electrocardiogram (ECG) pattern previously considered a normal variant, especially in young individuals.
• Recent studies indicate a higher prevalence of ER in patients with idiopathic ventricular fibrillation, suggesting a potential association with cardiac events.
• ER is characterized by J-point elevation (≥ 2 mV) in inferior or lateral leads, manifesting as QRS slurring or notching.

Purpose of the Study:

• To re-evaluate the clinical significance of the early repolarisation (ER) pattern on ECG.
• To identify high-risk features associated with sudden cardiac death (SCD) in patients with ER.
• To emphasize the need for physician awareness and appropriate management strategies for ER and Early Repolarisation Syndrome (ERPS).

Main Methods:

• Analysis of ECG findings in patients with and without a history of ventricular fibrillation.
• Identification of specific ECG characteristics and clinical factors associated with increased risk of SCD.
• Review of current understanding of the electrophysiological basis of ER.

Main Results:

• J-point elevation in ER is a marker of increased transmural heterogeneity of ventricular repolarisation, increasing vulnerability to ventricular tachyarrhythmias.
• High-risk features for SCD in ER patients include male gender, family history of syncope or SCD, inferior or global ER patterns, terminal QRS notching, J wave amplitude > 0.2 mV, and ST segment elevation direction.
• Early Repolarisation Syndrome (ERPS) applies to patients with ER ECG findings and symptomatic arrhythmias.

Conclusions:

• Early repolarisation (ER) is not always a benign finding and can be associated with an increased risk of ventricular arrhythmias and sudden cardiac death.
• Complete cardiac evaluation is recommended for all patients with an ER pattern on ECG.
• Management options for ERPS include antiarrhythmic drugs, implantable cardioverter-defibrillators (ICDs), and radiofrequency ablation, tailored to high-risk individuals.