Novel indexes of heterogeneity of ventricular repolarization in subjects with early repolarization pattern

Letsas, Κonstantinos P.; Charalampous, Charalampos; Korantzopoulos, Panagiotis; Tsikrikas, Spyros; Bramos, Dimitrios; Κόλλιας, Γεώργιος; Efremidis, Michael; Sideris, Antonios

doi:10.1093/europace/eur390

Cited by 28 publications

(33 citation statements)

References 34 publications

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“…189, 242 The presence of co-existing Brugada ECG pattern (J waves in V1-V3) or short QT intervals in subjects with ER also suggests a more malignant nature. 243, 244 …”

Section: Risk Stratification Of Patients With Ersmentioning

confidence: 99%

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

et al. 2016

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“…189, 242 The presence of co-existing Brugada ECG pattern (J waves in V1-V3) or short QT intervals in subjects with ER also suggests a more malignant nature. 243, 244 …”

Section: Risk Stratification Of Patients With Ersmentioning

confidence: 99%

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

et al. 2016

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“…38,39 Patients with early repolarization do not seem to display significantly higher inducibility in comparison to those without early repolarization. 38,39 Patients with early repolarization do not seem to display significantly higher inducibility in comparison to those without early repolarization.…”

Section: Risk Stratification Of Vf In Patients With Ersmentioning

confidence: 96%

“…39 In addition, benign early repolarization is associated with a significantly shorter QTc interval, whereas malignant early repolarization is associated with a significantly longer QRS duration. In contrast, the malignant form of ERS, involving horizontal/descending ST-segment variation, is associated with older age and increased ECG signs of coronary artery disease.…”

Section: Early Repolarization: Benign or Malignant?mentioning

confidence: 99%

Early Repolarization Syndrome: Electrocardiographic Signs and Clinical Implications

Rezuş

Floria

Moga

et al. 2013

Noninvasive Electrocardiol

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Early repolarization syndrome (ERS) was previously considered as a benign variant, but it has recently emerged as a risk marker for idiopathic ventricular fibrillation (VF) and sudden death. As measured by electrocardiogram (ECG), early repolarization is characterized by an elevation of the J point and/or ST segment from the baseline by at least 0.1 mV in at least two adjoining leads. In particular, early repolarization detected by inferior ECG leads was found to be associated with idiopathic VF and has been termed as ERS. This condition is mainly observed in young men, athletes, and blacks. Also, it has become evident that electrocardiographic territory, degree of J-point elevation, and ST-segment morphology are associated with different levels of risk for subsequent ventricular arrhythmia. However, it is unclear whether J waves are more strongly associated with a depolarization abnormality rather than a repolarization abnormality. Several clinical entities can cause ST-segment elevation. Therefore, clinical and ECG data are essential for differential diagnosis. At present, the data set is insufficient to allow risk stratification in asymptomatic individuals. ERS, idiopathic VF, and Brugada syndrome (known as J-wave syndromes) are three clinical conditions that share many common ECG features; however, their clinical consequences are remarkably different. This review summarizes the current electrocardiographic data concerning ERS with clinical implications.

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“…In contrast, horizontal ER in the inferior leads persisted in 29% of cases. Haïssaguerre et al commented that exercise consistently reduced or eliminated ER 2 in ERS, whereas Letsas et al 30 also showed that ER disappeared at peak exercise in 44 out of 47 healthy individuals with ER but neither commented on differences between ascending and horizontal ER. Our group has previously shown that horizontal ER is more likely to persist during exercise and was also associated with a history of syncope.…”

Section: Exercise Ecgmentioning

confidence: 99%

The Prevalence and Significance of the Early Repolarization Pattern in Sudden Arrhythmic Death Syndrome Families

Mellor

Nelson

Robb

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-The early repolarization (ER) pattern is associated with sudden death and has been shown to be heritable. Its significance when identified in families affected by sudden arrhythmic death syndrome (SADS) remains unclear. Methods and Results-We analyzed 12-lead ECGs of 401 first-degree relatives of individuals who had died from SADS.The prevalence of ER patterns was compared with family-clustered controls. ER was more common in SADS family members than in controls (21% versus 8%; odds ratio: 5.14; 95% confidence interval, 3.37-7.84) independent of the presence of a familial cardiac diagnosis. Both ascending and horizontal ER patterns were more common. In addition, ER was investigated for associations with findings from ajmaline provocation (n=332), exercise ECG (n=304), and signalaveraged ECG (n=118) when performed. ER was associated with a trend toward late depolarization, in general was suppressed with exercise and was unaffected by ajmaline. Inferior and horizontal patterns were, however, more likely to persist during exercise. Augmentation of ER with ajmaline was rare. Conclusions-The ER pattern is more common in SADS family members than controls adjusted in particular for relatedness.The increased prevalence is irrespective of ER subtype and the presence of other inherited arrhythmia syndromes. ER may therefore represent an underlying heritable arrhythmia syndrome or risk factor for sudden death in the context of other cardiac pathology. The differing response of ER subtypes to exercise and ajmaline provocation suggests underlying mechanisms of both abnormal repolarization and depolarization. (Circ Arrhythm Electrophysiol. 2016;9:e003960.

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Novel indexes of heterogeneity of ventricular repolarization in subjects with early repolarization pattern

Abstract: Individuals with ER display an increased TDR that may be related to an increased arrhythmic risk.

Cited by 28 publications

References 34 publications

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

Early Repolarization Syndrome: Electrocardiographic Signs and Clinical Implications

The Prevalence and Significance of the Early Repolarization Pattern in Sudden Arrhythmic Death Syndrome Families

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