Association of Early Repolarization and Sudden Cardiac Death During an Acute Coronary Event

Abstract

Background— Electrocardiographic early repolarization (ER) pattern has been previously associated with arrhythmic mortality and with an increased risk of ventricular fibrillation. We hypothesized that there is an association between ER and sudden cardiac death (SCD) during an acute coronary event. Methods and Results— The present study included 432 consecutive victims of SCD because of acute coronary event and 532 survivors of such an event, in whom 12-lead ECGs recorded before and unrelated to the event could be evaluated. SCDs were verified by medicolegal autopsy to be because of acute coronary event. ER was defined as an elevation of the QRS-ST junction in at least 2 inferior or lateral leads, manifested as QRS notching or slurring. The prevalence of ER pattern ≥0.1 mV was more common in cases (62/432; 14.4%) than controls (42/532; 7.9%) ( P =0.001). The victims of SCD were younger, were more commonly men and smokers, had lower body mass index, had elevated heart rate, had prolonged QRS complex, and had lower prevalence of history of prior cardiovascular disease than controls. After adjustments for baseline differences, the odds ratio for J waves without ST-segment elevation in the SCD group was 2.15 (95% CI, 1.20–3.85; P =0.01). Conclusions— Higher prevalence of ER in a standard 12-lead ECG in victims of SCD than in survivors of an acute coronary event suggests that the presence of ER increases the vulnerability to fatal arrhythmia during acute myocardial ischemia and provides a plausible mechanistic link between this ECG pattern and higher arrhythmic mortality of middle-aged/elderly subjects.

Predictors of Ventricular Fibrillation at Reperfusion in Patients With Acute ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

“…The association of a initially existing J-wave pattern with future arrhythmic complications during acute STEMI was explained by the presence of heterogeneity of ventricular repolarization as a substrate predisposing to the development of ventricular arrhythmias in the setting of an acute ischemia trigger (22). In our study J-wave point elevation was observed in 0,2%, that is much lower than in the above mentioned studies -11-16% (18,19), and than the reported early repolarization (ER) prevalence in general population -4.5% (23). However, ER is known to be an age-dependant phenomenon, and in age group 60-70 years, corresponding the average age at the moment of historical ECG in our study, its prevalence appears to be in the range of 1.5% in women and 2-3% in man (23) thus being in line with our observations.…”

“…Recently, a number of studies reported the association between J-wave pattern on historical ECG and life-threating ventricular arrhythmias and sudden death during acute ischemic event (18)(19)(20)(21). The association of a initially existing J-wave pattern with future arrhythmic complications during acute STEMI was explained by the presence of heterogeneity of ventricular repolarization as a substrate predisposing to the development of ventricular arrhythmias in the setting of an acute ischemia trigger (22).…”

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers

“…On the other hand, studies showed a higher mortality risk in subjects with the ER pattern in specific clinical scenarios (heart failure, ischaemic heart disease) [28,29] in the general population [24] and, which might indeed be concerning, in high endurance athletes [10].…”

Nichtinvasive Elektrophysiologie

“…Hier sind Daten hinsichtlich der Prävalenz einer ER bei herzgesunden Probanden sowie Prävalenz und Prognose einer ER in einer großen populationsbasierten Studie publiziert worden [1,2]. Ferner rückt mehr und mehr die prognostische Wertigkeit einer ER bei Patienten mit akuten Koronarsyndromen in den Fokus des Interesses [3,4]. Hinsichtlich neuer nichtinvasiver elektrophysiologischer Parameter wurde erstmals ein interessanter Prädik-tor für den plötzlichen Herztod beschrieben, der nach einer Belastungsuntersuchung die Erholung des räumlichen QRS/ T-Winkels beschreibt [5].…”

“…In zwei weiteren Studien [3,4] wurde der Hypothese nachgegangen, dass das Vorliegen einer ER mit einer erhöh-ten Vulnerabilität für lebensbedrohliche Tachyarrhythmien während eines akuten koronaren Ereignisses/eines Myokardinfarkts einhergeht. In der Studie von Tikkanen et al [3] …”