The normal RS-T segment elevation variant∗

Wasserburger, Richard H.; Alt, William J.

doi:10.1016/0002-9149(61)90204-1

Cited by 237 publications

(106 citation statements)

References 13 publications

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“…In the BER pattern, the J point itself frequently is notched or irregular. This finding, although not diagnostic of BER, is highly suggestive of the diagnosis [11,13,15].…”

Section: Benign Early Repolarizationmentioning

confidence: 75%

“…The normal concavity of the initial, upsloping portion of the ST segment is preserved. Eighty percent to 90% of individuals demonstrate STE less than 2 mm in the precordial leads and less than 0.5 mm in the limb leads; only 2% of cases of BER manifest STE greater than 5 mm [13,14]. In the BER pattern, the J point itself frequently is notched or irregular.…”

Section: Benign Early Repolarizationmentioning

confidence: 99%

“…3-5) includes the following features: STE [1]; concavity of the initial, upsloping portion of the ST segment [2]; notching or slurring of the J point [3]; symmetric, concordant, prominent T waves [4]; widespread distribution of the electrocardiographic abnormalities [5]; and temporal stability [6,13,14].…”

Section: Benign Early Repolarizationmentioning

confidence: 99%

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ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes

Brady

2006

Emergency Medicine Clinics of North America

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The evaluation of the chest pain patient suspected of acute coronary syndrome (ACS) represents the major indication for electrocardiograph (ECG) performance in the emergency department (ED) and prehospital settings [1]. The ECG demonstrates significant abnormality in a minority of these patients, ranging from minimal nonspecific ST segment/T wave changes to pronounced STE and T wave abnormalities, including the prominent T wave, the inverted T wave, and the nonspecific T wave (Figs. 1 and 2). The ECG syndromes responsible for these various abnormalities include potentially malignant entities, such as ACS and cardiomyopathy, and less concerning patterns, such as benign early repolarization (BER) or ventricular paced rhythms (VPR) [2][3][4].In a study considering all chest pain patients with electrocardiographic ST segment depression (STD), the following clinical syndromes were responsible for the ECG abnormality: ACS, 26%; left ventricular hypertrophy (LVH), 43%; bundle branch block (BBB), 21%; VPR, 5%; left ventricular aneurysm, 3%; and other patterns, 1% [5]. Similarly, STE is a fairly common finding on the ECG of the chest pain patient and frequently does not indicate STE acute myocardial infarction (AMI). One prehospital study of adult chest pain patients revealed that, of patients manifesting STE who met criteria for fibrinolysis, most were not diagnosed with AMI; rather, LVH and left BBB were found more frequently [6]. Furthermore, in two reviews of adult ED chest pain patients with STE on ECG, the ST segment abnormality resulted from AMI in only 15%-31% of these populations; LVH, seen in 28%-30% of these patients, was a frequent cause of this STE. Other findings responsible for this STE included BER, acute

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“…In the BER pattern, the J point itself frequently is notched or irregular. This finding, although not diagnostic of BER, is highly suggestive of the diagnosis [11,13,15].…”

Section: Benign Early Repolarizationmentioning

confidence: 75%

Section: Benign Early Repolarizationmentioning

confidence: 99%

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ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes

Brady

2006

Emergency Medicine Clinics of North America

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“…9,[13][14][15]17 A recent work by Noseworthy et al 9 reported that, in a subgroup of football and rowing athletes, J-point elevation on surface ECG was not significantly associated with any parameter of structural remodeling typical of the athlete's heart, supporting the hypothesis that the evidence of J-point elevation is a mere electrophysiological phenomenon and that it is not related to any form of exerciseinduced LV remodeling.…”

Section: Discussionmentioning

confidence: 93%

Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Biasco

Cristoforetti

Castagno

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-J-point elevation is common in athletes; nevertheless, the influence of structural changes associated with the athlete's heart and its prognostic impact are still debated. Our aim was to investigate the prevalence of J-point elevation, the associated clinical, electrocardiographic, and echocardiographic characteristics and its impact on long-term outcome in elite soccer players. Methods and Results-Clinical, electrocardiographic, and cardiopulmonary exercise test data from 332 male professional soccer players were retrospectively analyzed. For 235 (70.7%) athletes echocardiographic data were also available. J-point elevation was defined as an elevation ≥1 mm in ≥2 contiguous leads. Long-term follow-up data were obtained for all athletes, whereas univariate and multivariable analyses were performed to assess the associated characteristics. Overall, 118 (35.6%) athletes showed a J-point elevation ≥1 mm. At multivariable analysis a significant direct association of interventricular septum thickness (odds ratio for 1 SD increase, 1.361; 95% confidence interval, 1.019-1.817; P=0.036) and Sokolow-Lyon index (odds ratio for 1 SD increase, 1.367; 95% confidence interval, 1.026-1.822; P=0.033) and an inverse association of baseline heart rate (odds ratio for 1 SD increase, 0.686; 95% confidence interval, 0.508-0.927; P=0.011) with J-point elevation were observed. During a long-term follow-up (median, 13.3 years; first and third quartiles, 10.1-17.0 years), a low mortality rate was observed, not related to cardiovascular causes. Conclusions-The correlation between J-point elevation and interventricular septum thickness suggests a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation. After a long-term follow-up, no cardiac death was observed. (Circ Arrhythm Electrophysiol. 2013;6:1178-1184.)

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“…Recently different studies have challenged this view and showed a significant association with life-threatening arrhythmias. [1][2][3][4][5] In 2008 Haïssaguerre et al first reported an increased prevalence of a particular pattern of ER on the resting 12-lead ECG of patients with history of idiopathic ventricular fibrillation (VF) (see Figure 1). 2 In these patients, ER was characterised by elevation of the QRS-ST segment junction of at least 0.1 mV above the baseline level, manifesting as QRS slurring (a smooth transition from the QRS complex to the ST segment) or notching (a positive J deflection of at least 1 mm inscribed on the S wave) in two adjacent inferior (II, III and aVF), lateral (I, aVL, and V4-V6), or infero-lateral leads.…”

mentioning

confidence: 99%

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

Conte

Caputo

Regoli

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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General understanding of early repolarisation (ER) has dramatically changed in the last decade. For several years, ER has been considered a benign electrocardiographic (ECG) finding with high prevalence in the general population. Recently different studies have challenged this view and showed a significant association with life-threatening arrhythmias. [1][2][3][4][5] In 2008 Haïssaguerre et al. first reported an increased prevalence of a particular pattern of ER on the resting 12-lead ECG of patients with history of idiopathic ventricular fibrillation (VF) (see Figure 1). 2 In these patients, ER was characterised by elevation of the QRS-ST segment junction of at least 0.1 mV above the baseline level, manifesting as QRS slurring (a smooth transition from the QRS complex to the ST segment) or notching (a positive J deflection of at least 1 mm inscribed on the S wave) in two adjacent inferior (II, III and aVF), lateral (I, aVL, and V4-V6), or infero-lateral leads. The ER pattern was observed in 31 % of patients with idiopathic VF and in 5 % of healthy control subjects.Moreover, patients with idiopathic VF and ER pattern presented a higher risk of experiencing an arrhythmic recurrence during a 5-year follow-up.2 This observation was confirmed by a case-control study showing that J-point elevation in the inferior and lateral leads is more frequent in patients with idiopathic VF than in matched control subjects (27 % versus 8 % in inferior leads; 13 % versus 1 % in lateral leads).3 Conversely, ER localised exclusively in V4 to V6 occurs with similar frequency among patients and healthy subjects.

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The normal RS-T segment elevation variant∗

Cited by 237 publications

References 13 publications

ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes

ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes

Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

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