Early Repolarisation - What Should the Clinician Do?

Abstract

The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.

Keywords: Early repolarisation; idiopathic ventricular fibrillation.

Figure 1:. Prominent early repolarisation manifest as inferior J-point slurring and lateral J-point notching each >2 mm in two contiguous leads.

Figure 2:. Horizontal ST-segment following early repolarisation with prolonged QTc.

Figure 3:. Prominent lateral J-point notching >4 mm with ascending ST-segment and inferior J-point slurring with ascending ST-segment.

Figure 4:. Inferior J-point elevation with horizontal ST segment.