A Clinical Approach to Early Repolarization

Obeyesekere, Manoj; Klein, George J.; Nattel, Stanley; Leong‐Sit, Peter; Gula, Lorne J.; Skanes, Allan C.; Yee, Raymond; Krahn, Andrew D.

doi:10.1161/circulationaha.112.143149

Cited by 36 publications

(36 citation statements)

References 52 publications

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“…This wave corresponds to the current flowing from the endocardium to epicardium during phase 1. The characteristic notch on the epicardial action potential coincides with the J-wave on the surface ECG, also, they change parallelly, ventricular activation clearly influencing the appearance of J-wave [8,9].…”

Section: Molecular Basis Electrophysiological Backgroundmentioning

confidence: 99%

“…Independently of the initiating mechanism, the ventricular tachyarrhythmia is maintained by local transmural reentry induced by the increased AP gradients. The genetic basis for early repolarization syndrome is not entirely clarified, but today's data show seven different genes encoding cardiac ion channels that are associated with early repolarization syndrome, more exactly, 3 K + channel related, 3 Ca 2+ channel related and 1 Na + channel related genes were found to be involved [2,9].…”

Section: Molecular Basis Electrophysiological Backgroundmentioning

confidence: 99%

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The Early Repolarization ECG Pattern – An Update

Szabó

Fárr

Kocsis

et al. 2017

Acta Medica Marisiensis

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Early repolarization pattern (ERP), a form of J-wave syndromes, was considered long time a benign ECG phenomenon. However, recent data confirmed that certain phenotypes of ERP are related to an increased risk of sudden cardiac death (idiopathic ventricular fibrillation). Our paper gives a short and practical update regarding the main issues related to ERP: epidemiological data, molecular and electrophysiological background, clinical significance and risk stratification. At the end, the future directions of research and clinical management related to ERP are presented.Keywords: J-wave, early repolarization syndrome, sudden cardiac death Introduction. History From the beginning of electrocardiography, so called idiopathic J-waves were found on the ECG recordings of many species, including humans. The J-point on ECG is defined as the transition between the end of the QRS complex and the ST segment. Deviation of this point from the isoelectric line determine the presence of J-deflection (wave), which could be followed by upsloping or horizontal ST-segment elevation, determining the appearance of early repolarization ECG pattern (ERP). The ERP was first described in 1936 by Shipley and Hallaran, who studied 200 young healthy men and women and described the Jdeflection as notching of the descending part of the QRS complex [1][2][3].ERP was considered previously as a benign, "innocent", ECG phenomenon, as a distinct form of the so called J-wave syndromes (which include also the Brugada syndrome). However, in the last ten years, epidemiological and case-control studies found some forms of ERP to be predictors and risk factors for sudden cardiac death (primary ventricular fibrillation). This is particularly true, when the ST segment has a horizontal or descending direction in the inferior and/or infero-lateral leads. The risk is even higher when the amplitude of J-wave is greater than 0.2 mV [2].

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Section: Molecular Basis Electrophysiological Backgroundmentioning

confidence: 99%

Section: Molecular Basis Electrophysiological Backgroundmentioning

confidence: 99%

The Early Repolarization ECG Pattern – An Update

Szabó

Fárr

Kocsis

et al. 2017

Acta Medica Marisiensis

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“…10 However, there has been evidence suggesting that the early repolarisation pattern may be associated with a risk for VF, depending on the location of early repolarisation, magnitude of the J wave and degree of ST elevation. 2,11,12 In a large study on a communitybased general population of 10,864 middle-aged subjects, an early repolarisation pattern with J-point elevation of at least 0.1 mV in the inferior leads of a resting ECG was associated with an increased risk of death from cardiac causes. 13 In addition, among patients with a history of idiopathic ventricular fibrillation, an increased prevalence of early repolarisation, (up to 23 %), defined as an elevation of the QRS-ST junction of at least 0.1 mV from baseline in the inferior or lateral lead, manifested as QRS slurring or notching, has been detected.…”

Section: Clinical Significancementioning

confidence: 99%

Early Repolarisation Syndrome – New Concepts

Katritsis

Gersh

2015

Arrhythmia &Amp; Electrophysiology Review

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Early repolarisation pattern is defined electrocardiographically by a distinct J wave or J-point elevation that is either a notch or a slur of the terminal part of the QRS entirely above the baseline, with or without ST-segment elevation. The peak of the notch or slur (J p ) should be ≥0.1 mV in two or more contiguous leads, excluding leads V1 to V2 (see Figure 1).1,2 Early repolarisation syndromes (ERS) refer to sudden cardiac death or documented VT/VF in individuals with an early repolarisation pattern.A prominent J wave has been long observed in cases of hypothermia hypercalcaemia and ischaemia.3 The term J-wave syndromes usually denotes inherited conditions such as ERS and the Brugada syndrome, 4 which are due to mutations affecting calcium, potassium and sodium channels and may contribute to overlap syndromes. 4,5 Genetics and PathophysiologyThe J-wave deflection occurring at the QRS-ST junction (also known as the Osborn wave) was first described in 1953 and is seen in many conditions such as acute ischaemia (especially in true posterior myocardial infarction), hypothermia, hypercalcaemia, brain injury, acidosis and early repolarisation syndromes. An increase in net repolarising current, due to either a decrease of inward Na + or Ca 2+ currents (I Na, and I Ca,L ), or augmentation of outward currents, such as Ito, I K-ATP, and I K-ACh, lead to augmentation of the J wave or the appearance of ST-segment elevation that is more prominent during slow heart rates.Overlap with other syndromes may be seen. Mutations in the SCN10A gene may produce patterns of Brugada, early repolarisation and conduction disease, 5 and a high prevalence of early repolarisation in short QT syndrome has also been reported. 6 Physiological heterogeneity of electrical properties and transmural gradients in ion channel distribution in the endocardial, midmyocardial (M cells) and epicardial layers result in regional differences in electrophysiological properties. Clinical SignificanceThe early repolarisation pattern has long been considered to be a benign ECG manifestation (6-13 % in the general population), that is seen more commonly in young healthy men and athletes (22-44 %) and its clinical significance has been questioned. 7 In a recent report on professional athletes, a correlation between J-point elevation and interventricular septum thickness was observed, suggesting a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation, and no cardiac death was observed in a median of 13 years follow-up. 8 Similarly, in the CARDIA study, the presence of early repolarisation in young adults was not associated with higher risk of death during long-term follow-up. 9 The possibility that false tendons, e.g. discrete, fibromuscular structures that transverse the LV cavity, are related to the genesis of J waves has also been raised. 10 However, there has been evidence suggesting that the early repolarisation pattern may be associated with a risk for VF, depending on the location of early repol...

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“…27 The early repolarization pattern has long been considered to be a benign ECG manifestation (6-13 % in the general population)…”

Section: Early Repolarization and St-t Abnormalitiesmentioning

confidence: 99%

“…29 However, there are data indicating that the early repolarization pattern may be associated with a risk for ventricular fibrillation (VF) and SCD, depending on the location of early repolarization, magnitude of the J-wave and degree of any ST elevation present. 27,[30][31][32][33][34][35] A horizontal/descending type (defined as ≤0.1 millivolt (mV) elevation of the ST-segment within 100 ms after the J-point) in the inferior leads, as opposed to a rapidly ascending ST-segment type, may help to identify those individuals who are clearly at risk (see Figures 3 and 4). 33,34 However, several obscure points remain with this syndrome.…”

Section: Early Repolarization and St-t Abnormalitiesmentioning

confidence: 99%

The Electrocardiogram in Athletes Revisited

Katritsis

2013

Arrhythmia &Amp; Electrophysiology Review

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Cardiovascular-related sudden death is the leading cause of mortality in athletes during sport. Thus, it is of clinical importance to identify ECG changes that represent normal adaptation in athletes, and differentiate them from truly pathological findings. However, a distinction between adaptive and pathological ECG changes in athletes is not always easy. This article discusses exercise-induced ECG changes and the differential diagnosis of conditions that present with similar ECG patterns.

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A Clinical Approach to Early Repolarization

Abstract: Osborn9 reported that dogs subjected to hypothermia developed spontaneous VF that was preceded by the development of J-waves. The J-wave was attributed to a current of injury (hence the term J) and later coined the term Osborn wave.

Cited by 36 publications

References 52 publications

The Early Repolarization ECG Pattern – An Update

The Early Repolarization ECG Pattern – An Update

Early Repolarisation Syndrome – New Concepts

The Electrocardiogram in Athletes Revisited

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