Early repolarization
Dimitrios D. Manolatos, MD, PhD, FESC
Second Department of CardiologyEvangelismos General Hospital of Athens
Athens, Greece
WHATS THE NEXT STEP
•EP STUDY
•LOOP RECORDER
•TILTING TEST
•DISCHARGE
Definition of early repolarization
J-point ≥ 1mm (notching vs. slurring) in two contiguousleads (lateral or inferolateral) with or withoutconcomitant ST-segment elevation
N Engl J Med. 2008 May 8;358(19):2016-23
N Engl J Med. 2008 May 8;358(19):2016-23
N Engl J Med. 2008 May 8;358(19):2016-23
N Engl J Med. 2008 May 8;358(19):2016-23
Journal of Arrhythmia 2016;32:315–339
fragmentation
J Am Coll Cardiol 2015;66:470–7
Rapidly ascending (A) and horizontal (B) ST segment in the leads
deploying J waves (arrows).
Heart Rhythm 2011
Heart Rhythm 2016;13:894–902
Regression analysis demonstrated that QTc
interval (odds ratio [OR] per 10 ms: 1.15,
95% confidence interval [CI} 1.02–1.30),
maximal J-wave amplitude (OR per 0.1 mV:
1.68, 95% CI 1.23–2.31), lower T/R ratio
(OR per 0.1 unit: 0.62, 95% CI 0.47–0.81),
presence of low-amplitude T waves (OR 3.53,
95% CI 1.26–9.88). and presence of J waves
in the inferior leads (OR 2.58, 95% CI 1.18–
5.65) were associated with malignant ER.
Distinguishing malignant from benign J-waves
“Malignant”
ER
“Benign”
ER
Clinical data
Gender (males) +++ -
Syncope without prodromes +++ -
Syncope with prodromes - +++
Syncope at rest/seizures at
night
++ -
Aborted SCD ++++ -
Family history of SCD ++ -
Family history of BrS + -
Distinguishing malignant from benign J-waves
“Malignant” ER “Benign” ER
ECG criteria
J-point amplitude > 2 mm ++++ -
J-point amplitude > 1 mm ++ -
Notched J-point (J-wave) ++ -
Slurred J-point + -
Inferior ER ++ -
Lateral ER - +
Inferolateral ER +++ -
Global ER ++++ -
Ascending ST-segment - ++
Descending ST-segment +++ -
Low amplitude T-waves V5-6 +++ -
International Journal of Cardiology 2007;114:390-392
Early repolarization associated with ventricular fibrillation
N Engl J Med. 2008 May 8;358(19):2016-23
Journal of Arrhythmia 2016;32:315–339
Early repolarization associated with VF:
Increased J-point amplitude before VF
Europace 2013; 15:1389–1406
RARELY
WILL NOT