Early repolarisation – benign or early sign?

14/04/2023

Take Home Messages
Early repolarisation pattern is a term describing J point elevation with slurring or notching. This pattern has been related to mildly increased risk of ventricular arrhythmias and sudden cardiac death. Early repolarisation syndrome can be diagnosed in patients with early repolarisation pattern on ECG with previous history of VF or sudden cardiac death. High risk features include changes seen in multiple leads, descending ST segments and J point elevation ≥ 2mm. Asymptomatic patients incidentally found to have early repolarisation pattern do not routinely require further investigation.

Take Home Messages

Early repolarisation pattern is a term describing J point elevation with slurring or notching.
This pattern has been related to mildly increased risk of ventricular arrhythmias and sudden cardiac death.
Early repolarisation syndrome can be diagnosed in patients with early repolarisation pattern on ECG with previous history of VF or sudden cardiac death.
High risk features include changes seen in multiple leads, descending ST segments and J point elevation ≥ 2mm.
Asymptomatic patients incidentally found to have early repolarisation pattern do not routinely require further investigation.

Introduction

Early repolarisation is a commonly seen ECG pattern, reported in 13% of population (1). According to the Heart Rhythm Society and European Heart Rhythm Association 2013 consensus paper (2), early repolarisation pattern (ERP) can be diagnosed if at least 1mm J point elevation can be seen in at least two contiguous inferior and/or lateral leads. J waves were first noticed during hypothermia and are commonly known as Osborn waves. They were then noted in young, fit people and were considered a juvenile pattern.

It was regarded a benign finding until a study by Haissaguerre (3) reported increased prevalence of ERP in patients with a history of idiopathic VF compared to the healthy population. This study started a debate on whether the commonly seen pattern meant increased risk of sudden cardiac death.

The presence of the J wave has been shown to increase the probability of VF from 3.4 in 100,000 to 11 in 100,000 (4). The fact that a commonly seen ECG variant may, however infrequently, correlate with potentially fatal consequences poses a significant dilemma.

The question has proven difficult to answer with some studies confirming Haissaguerre’s finding but others failing to link ERP to increased arrhythmic risk (5-9).

Early repolarisation – benign or early sign?

Introduction

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