Early repolarization

Abstract

Summary:Early repolarization (ER) is an enigma. The purpose of this review is to reemphasize the overall electrocardiographic (ECG) pattern of this normal ST variant which continues to challenge the clinician because of its similarity to the current of injury potential to myocardium or an acute pericarditis. The data were provided from the studies identified through computerized searches of Medline, Toxline, Oxford, Agricola, and Bios Afterdark, Cumulative index, and a review of bibliographies of relevant articles on the related subjects. Early repolarization has elevated, upward, concave ST segments, located commonly in precordial leads, with reciprocal depression in aVR, tall, peaked and slightly asymmetrical T waves with notch, and slur on the R wave. The other accompanying features in the ECG are vertical axis, shorter and depressed P-R interval, abrupt transition, counterclockwise rotation, presence of U waves, and sinus bradycardia. Males dominate and patients are often younger than 50 years of age. The incidence of 1 to 2% is found equally common in all races. Degree and incidence of ST elevation decrease as age advances. Exercise or isoproterenol administration may normalize the ST segment. Early repolarization is a benign condition. If the ECG conforms to a classical pattern of ER on serial ECGs, it would exclude the unnecessary hazards of present day revascularization therapy for myocardial infarction such as primary angioplasty or thrombolytic therapy, or aggressive management of acute pericarditis, and so forth. This review concludes with a discussion of comparative ECG features of ER, pericarditis, and myocardial infarction, and provides an algorithm for diagnostic management of patients suffering from these conditions. Key words: ST segment in early repolarization, race and early repolarization, early repolarization and myocardial infarction, early repolarization and pericarditis, arrhythmia in early repolarization, PR interval and early repolarization. early repolarization and gender

Incidence and Prognostic Value of Early Repolarization Pattern in the 12-Lead Electrocardiogram

“…[5][6][7][8] However, because ERP (defined by the modified criteria of Haïssaguerre and colleagues 7 ) appeared intermittently, we based our calculation on both prevalent and incident cases and found that 23.9% manifested ERP at least once during follow-up, indicating that ERP was not a rare ECG finding. In past studies, only the prevalence, not incidence, of ERP has been reported because longitudinal studies covering the period before the diagnosis of ERP were lacking.…”

“…Using criteria similar to those of Haïssaguerre and colleagues, 7 we defined ERP cases as having (1) an elevation of the QRS-ST junction (J point) in notching formation (positive J deflection inscribed on the S wave) or of the ST segment in slurring formation (smooth transition from QRS complex to the ST segment) in at least 2 leads and (2) an amplitude of QRS-ST junction (J point) or ST-segment elevation Ն0.1 mV above the baseline as QRS notching or slurring in the inferior leads (II, III, aVF), lateral leads (I, aVL, V 4 through V 6 ), or both 7 ( Figure 1) at least once during follow-up. In slurring formation, because the transition from QRS complex to ST segment is smooth or the J point may be hidden in the QRS complex, we used Ն0.1 mV of the ST-segment elevation to indicate high-takeoff QRS-ST junction as the criterion.…”

ST Segment Elevation Besides Acute Myocardial Infarction

“…The early repolarization syndrome (ERS) is a common electrocardiographic variant characterized by J-point elevation manifested either as QRS slurring (at the transition from the QRS segment to the ST segment) or notching (a positive defection inscribed on terminal S wave), STE with upper concavity and prominent T waves in at least 2 contiguous leads [7][8][9][10] . In most of the studies elevation of the J point and/or ST-segment from the baseline by at least 0.1 mV was considered definitive of ER 9,11 (figure 2).…”

Early Repolarization Syndrome - A New Electrical Disorder Associated With Sudden Cardiac Death -

“…7,8,17, 18 In most of the studies elevation of the J point and/or STsegment from the baseline by at least 0.1 mV was considered definitive of ER (Figure). 3,8…”