Early repolarization: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
| Line 15: | Line 15: | ||
** Early repolarization is rarely associated with a primary arrythmogenic disorder that manifests as idiopathic ventricular fibrillation. Genetic predisposition seems to play a role in this group of people. In addition, early repolarization seems to cause arrhythmia during sleep or at rest in the absence of any physical activity.<ref name="Obeyesekere-2013">{{Cite journal | last1 = Obeyesekere | first1 = MN. | last2 = Klein | first2 = GJ. | last3 = Nattel | first3 = S. | last4 = Leong-Sit | first4 = P. | last5 = Gula | first5 = LJ. | last6 = Skanes | first6 = AC. | last7 = Yee | first7 = R. | last8 = Krahn | first8 = AD. | title = A clinical approach to early repolarization. | journal = Circulation | volume = 127 | issue = 15 | pages = 1620-9 | month = Apr | year = 2013 | doi = 10.1161/CIRCULATIONAHA.112.143149 | PMID = 23588960 }}</ref> | ** Early repolarization is rarely associated with a primary arrythmogenic disorder that manifests as idiopathic ventricular fibrillation. Genetic predisposition seems to play a role in this group of people. In addition, early repolarization seems to cause arrhythmia during sleep or at rest in the absence of any physical activity.<ref name="Obeyesekere-2013">{{Cite journal | last1 = Obeyesekere | first1 = MN. | last2 = Klein | first2 = GJ. | last3 = Nattel | first3 = S. | last4 = Leong-Sit | first4 = P. | last5 = Gula | first5 = LJ. | last6 = Skanes | first6 = AC. | last7 = Yee | first7 = R. | last8 = Krahn | first8 = AD. | title = A clinical approach to early repolarization. | journal = Circulation | volume = 127 | issue = 15 | pages = 1620-9 | month = Apr | year = 2013 | doi = 10.1161/CIRCULATIONAHA.112.143149 | PMID = 23588960 }}</ref> | ||
* In addition, early repolarization seems to have different patterns which have different clinical significance. Hence, a standardized evaluation of early repolarization is needed. | * In addition, early repolarization seems to have different patterns which have different clinical significance. Hence, a standardized evaluation of early repolarization is needed.apidly ascending. Early repolarization patterns that demonstrate a rapidly ascending ST segment after the J point are almost always benign.<ref name="De Ambroggi-">{{Cite journal | last1 = De Ambroggi | first1 = L. | last2 = Sorgente | first2 = A. | last3 = De Ambroggi | first3 = G. | title = Early repolarization pattern: Innocent finding or marker of risk? | journal = J Electrocardiol | volume = 46 | issue = 4 | pages = 297-301 | month = | year = | doi = 10.1016/j.jelectrocard.2013.02.008 | PMID = 23540936 }}</ref> | ||
*A case control study of 120 post [[MI]] patients with [[ICD|implantable cardioverter defibrillators]] (ICDs) demonstrated that early repolarization was more frequently observed among patients with documented episodes of VT/VF (32% vs. 8%, p=0.005). The leads demonstrating early repolarization were more often the inferior leads (23% vs. 8%, p=0.03). A trend was observed for the lateral leads (V4-V6) as well (12% vs. 3%, p=0.11). In contrast, leads I and aVL were not commonly involved (3% vs. 0%). The morphology of the ST segment was critical and a notch in the ST segment was observed more frequently among patients with VT/VF (28% vs. 7%, p=0.008). In contrast, J-point elevation and slurring of the ST segment surprisingly were not associated with ventricular arrhythmias.<ref>Patel RV et al; doi: 10.1161/CIRCEP.109.921130</ref> | *A case control study of 120 post [[MI]] patients with [[ICD|implantable cardioverter defibrillators]] (ICDs) demonstrated that early repolarization was more frequently observed among patients with documented episodes of VT/VF (32% vs. 8%, p=0.005). The leads demonstrating early repolarization were more often the inferior leads (23% vs. 8%, p=0.03). A trend was observed for the lateral leads (V4-V6) as well (12% vs. 3%, p=0.11). In contrast, leads I and aVL were not commonly involved (3% vs. 0%). The morphology of the ST segment was critical and a notch in the ST segment was observed more frequently among patients with VT/VF (28% vs. 7%, p=0.008). In contrast, J-point elevation and slurring of the ST segment surprisingly were not associated with ventricular arrhythmias.<ref>Patel RV et al; doi: 10.1161/CIRCEP.109.921130</ref> | ||
Revision as of 18:20, 22 July 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: early repolarization pattern; early repol; early repol variant
Overview
Early repolarization is defined as notching or slurring of the morphology of the terminal QRS complex or J-point elevation >0.1 mV above baseline in at least 2 lateral or inferior leads.[1] Early repolarization is a normal ECG variant that is most commonly seen in young males. It can be confused with ST elevation MI and pericarditis.
Natural History, Complications and Prognosis
- Early repolarization pattern has been considered benign for a long time until some studies suggested an association between early repolarization and increased risk of arrhythmia, particularly ventricular fibrillation.[2] A possible explanation of the increased vulnerability to ventricular fibrillation associated with early repolarization is that early repolarization might be an indicator of transmural repolarization heterogeneity.[3]
- This association has shed light on the importance of evaluating early repolarization patterns and their prognostic implications. Whereas early repolarization is a common finding, idiopathic ventricular fibrillation is a rare entity which incidence ranges from 3:100000 to 10:100000.
- The majority of early repolarization patterns, especially if incidentally found in otherwise asymptomatic people with a negative family history, have no or minimal increased risk of arrhythmia.
- Early repolarization carries a higher risk of arrhythmia in patients with underlying cardiac pathology.
- Early repolarization is rarely associated with a primary arrythmogenic disorder that manifests as idiopathic ventricular fibrillation. Genetic predisposition seems to play a role in this group of people. In addition, early repolarization seems to cause arrhythmia during sleep or at rest in the absence of any physical activity.[2]
- In addition, early repolarization seems to have different patterns which have different clinical significance. Hence, a standardized evaluation of early repolarization is needed.apidly ascending. Early repolarization patterns that demonstrate a rapidly ascending ST segment after the J point are almost always benign.[4]
- A case control study of 120 post MI patients with implantable cardioverter defibrillators (ICDs) demonstrated that early repolarization was more frequently observed among patients with documented episodes of VT/VF (32% vs. 8%, p=0.005). The leads demonstrating early repolarization were more often the inferior leads (23% vs. 8%, p=0.03). A trend was observed for the lateral leads (V4-V6) as well (12% vs. 3%, p=0.11). In contrast, leads I and aVL were not commonly involved (3% vs. 0%). The morphology of the ST segment was critical and a notch in the ST segment was observed more frequently among patients with VT/VF (28% vs. 7%, p=0.008). In contrast, J-point elevation and slurring of the ST segment surprisingly were not associated with ventricular arrhythmias.[5]
Diagnosis
Differentiating Early Repolarization From Other Disorders
Early repolariztion must be differentiated from other causes of ST elevation including ST elevation MI and pericarditis.
Vagal Maneuvers and Bradycardia Exacerbate Early Repolarization
- The ST segment elevation of early repolarization is exacerbated by bradycardia, and carotid sinus massage or vagal maneuvers may also exacerbate the variant. This is not true in ST elevation MI or pericarditis.
Early Repolarization is Characterized by a Notch at the J Point
- In the figure shown below, the red arrow points to a characteristic notch which is present at the J point in early repolarization but not in ST elevation MI or pericarditis.:
Height of the J Point
Only lead V6 is used to distinguish between early repolarization and pericarditis. As shown in the figure below, if A/B > 25%, suspect pericarditis. If A/B < 25%, suspect early repolarization.
Electrocardiographic Examples
Shown below is an example of benign early repolarization with J point elevation, concave shaped up-sloping ST segment, and prominent T waves in the inferior and lateral leads:
Shown below is an example of early repolarization with notching of the J point in the lateral leads:
Shown below are examples of early repolarization and other normal variants of ST Elevation:
References
- ↑ Patel RV et al; doi: 10.1161/CIRCEP.109.921130
- ↑ 2.0 2.1 Obeyesekere, MN.; Klein, GJ.; Nattel, S.; Leong-Sit, P.; Gula, LJ.; Skanes, AC.; Yee, R.; Krahn, AD. (2013). "A clinical approach to early repolarization". Circulation. 127 (15): 1620–9. doi:10.1161/CIRCULATIONAHA.112.143149. PMID 23588960. Unknown parameter
|month=ignored (help) - ↑ Wu, SH.; Lin, XX.; Cheng, YJ.; Qiang, CC.; Zhang, J. (2013). "Early repolarization pattern and risk for arrhythmia death: a meta-analysis". J Am Coll Cardiol. 61 (6): 645–50. doi:10.1016/j.jacc.2012.11.023. PMID 23290543. Unknown parameter
|month=ignored (help) - ↑ De Ambroggi, L.; Sorgente, A.; De Ambroggi, G. "Early repolarization pattern: Innocent finding or marker of risk?". J Electrocardiol. 46 (4): 297–301. doi:10.1016/j.jelectrocard.2013.02.008. PMID 23540936.
- ↑ Patel RV et al; doi: 10.1161/CIRCEP.109.921130