The patterns and prevalence of early repolarization pattern (ER in paediatric populations from different ethnic backgrounds other than Caucasian have not been determined. Methods We analyzed ECGs of black children (ages xx-yy) who were prospectively recruited in the northwest Madagascar and compared them to age & sex matched Caucasian ethnicity individuals. ERP was defined by ≥0.1 mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. Results A total of 616 children were included. There was a trend toward a higher frequency of ERP in the Africans compared to the Caucasians (23.3% vs 17.1% respectively, p=0.053). The subtype (slurred versus notched) and location of ERP (lateral, inferior or infero-lateral) were significantly different in the two groups (p<0.001 and p=0.020, respectively). There was no significant difference in the number of high-risk ECG features of ERP (i.e. horizontal/descendent pattern, inferior or infero-lateral location or J-waves ≥2 mm) between Malagasy and Caucasian children. On the multivariate analysis, Malagasy ethnicity and faster heart rate were independent predictive factors of ERP (OR 3.57, 95%CI 2.04-6.25, p<0.001 and 0.98, 95%CI 0.962-0.987, p<0.001, respectively). Conclusions African children have an increased risk of ER compared to Caucasian counterparts. Future studies should clarify the clinical and prognostic significance of ERP in the pediatric population, and whether ethnicity has an impact on the outcomes.