Key result
New early repolarization criteria require a J wave without ST elevation, unlike the benign athlete variant.
Highlights the critical distinction between the classic benign early repolarization variant and the newer definition associated with malignant arrhythmias.
Supports distinguishing J-wave early repolarization from benign ST-elevation variant in athletes; leaves open prospective validation of arrhythmia risk.
Controversy has followed the groundbreaking and cornerstone paper of Haïssaguerre et al. Much of this controversy has been due to the use of the term "early repolarization pattern" and possible waveform morphologies on the standard 12-lead ECG ( it is 10 second strip) that could predict who will manifest the malignant arrhythmogenic syndrome described by Haïssaguerre et al. The standard ECG definition of early repolarization pattern (ERP) or early repolarization variant (ERV) since then has changed its clinical meaning for a surface electrocardiographic waveform from benign to malignant. The new definition of ERP/ERV contains only J wave but ST-segment elevation is no more obligatory. In the old definition, early repolarization pattern (ERP) or early repolarization variant (ERV) 3 is a well-recognized idiopathic electrocardiographic phenomenon considered to be present when at least two adjacent precordial leads show elevation of the ST segment, with values equal or higher than 1 mm. In the new electrocardiographic ERP concept, the ST segment may or may not be elevated and can be up-sloping, horizontal or down-sloping while in the old ERP/ERV concept it must be elevated at least 1 mm in at least two adjacent leads and the variant is characterized by a diffuse elevation of the ST segment of upper concavity, ending in a positive T wave of V2 to V4 or V5 and prominent J wave and ST-segment elevation predominantly in left precordial leads. The phenomenon constitutes a normal variant; it is almost a rule in athletes (present in 89% of the cases in this universe).
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Kukla et al. (2015) conducted a review in Early repolarization pattern. Early repolarization pattern definition was evaluated. The new electrocardiographic definition of early repolarization pattern requires a J wave but not ST-segment elevation, contrasting with the old benign variant present in 89% of athletes.
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