Benign Early Repolarization Phenomenon in Young Adults and Athletes: A Literature Review of Clinical Insights and Diagnostic Considerations

Figures

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  Figure 1. Flow diagram of the study selection process for the literature review on the benign early repolarization phenomenon in young adults and athletes

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  Figure 2. Representative electrocardiograms of two young patients with genetically confirmed early repolarization syndrome (ERS) A: Patient 1 was a 20-year-old male patient, identified with a mutation. He suffered syncopal episodes twice while exercising. ECGs showed bradycardia (HR = 46 bpm) and an ERP with notching in the inferior leads, leading to a diagnosis of ERS. B: Patient 2, a 17-year-old young male patient, presented with spontaneous VF on the background of syncope. ECGs exhibited sinus bradycardia (HR = 50 bpm) and an ERP with notching/slurring in a global pattern, thus diagnosed with ERS. Figure reproduced from Chen et al. licensed under CC-BY 4.0 [14]. ERP: effective refractory period; ERS: early repolarization syndrome; VF: ventricular fibrillation

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  Figure 3. ECG from a patient with acute pericarditis Diffuse ST-segment elevations (red arrows), PR-segment depressions (orange arrows), “fish-hook” morphology (gray arrows), and T-wave inversion in lead III are observed. Figure reproduced from Amoateng et al., licensed under CC-BY 4.0 [18].

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  Figure 4. J-wave dynamicity and fragmented QRS on 12-lead ECG a: ECG showing accentuation of early repolarization in inferior and lateral leads (red arrowheads); b: ECG without ER pattern (red arrowheads); c: fragmented QRS (fQRS) seen in anterior (V1–3), lateral (aVL), and right precordial (V3–4R) leads (red arrows). Figure reproduced from Yonezu et al., licensed under CC BY-NC-ND 4.0 [20]. ER: early repolarization

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  Figure 5. Continuous electrocardiographic tracings from a patient with electrical storm triggered by dynamic early repolarization Inferior J-waves with pause-dependent augmentation (red circles) precede the onset of ventricular fibrillation episodes, triggered by monomorphic premature ventricular complexes. Multiple defibrillations were required, and the patient eventually required VA-ECMO due to intractable VF. Figure reproduced from Steinfurt et al., licensed under CC BY-NC 4.0 [4]. VA-ECMO: venoatrial extracorporeal membrane oxygenation