Key result
Early repolarization in the inferior or inferolateral leads, previously considered benign, is associated with an increased risk for sudden cardiac death and idiopathic ventricular fibrillation.
Early repolarization, traditionally considered benign, is now recognized as a potential risk factor for sudden cardiac death and shares pathophysiological features with Brugada syndrome as part of the J-wave syndromes.
May prompt ECG review in syncope or family SCD history; leaves open prospective validation before risk stratification changes.
An early repolarization (ER) pattern characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation has been traditionally considered to be totally benign over the past decades. A flurry of data derived from recently published studies demonstrates that an ER pattern in inferior or inferolateral leads, named early repolarization syndrome (ERS), is associated with increased risk for sudden cardiac arrest (SCA), being responsible for some cases of idiopathic ventricular fibrillation (IVF). Current evidence support the notion that although ERS and Brugada syndrome (BrS) show discrete differences, they also share similar clinical, electrocardiographic and pathophysiological features, especially concerning the presence of amplified J-waves; thus, they can be considered to represent a continuous spectrum of phenotypic expression, termed J-wave syndromes. Research has provided us with fascinating insights into the underlying mechanisms responsible for repolarization abnormalities and we presently have more evidence to implement reliable risk stratification methods to patients with ER. However, many unanswered questions remain and still need to be addressed in future studies
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Bronis et al. (2012) conducted a review in J-wave syndromes (Early repolarization syndrome, Brugada syndrome, Idiopathic ventricular fibrillation). Early repolarization in the inferior or inferolateral leads, previously considered benign, is associated with an increased risk for sudden cardiac death and idiopathic ventricular fibrillation.
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