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Frühe Repolarisation

Ein Dilemma der Risikostratifikation

Early repolarisation

A dilemma of risk stratification

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die frühe Repolarisation tritt bei 1–9 % der Allgemeinbevölkerung auf und in 50–70 % der Fälle von idiopathischem Kammerflimmern. Bei der Mehrzahl der EKG-Befunde handelt es sich um eine harmlose EKG-Auffälligkeit und nur im Einzelfall sind die Veränderungen verantwortlich für das Auftreten lebensbedrohlicher Arrhythmien. Die Identifikation potenziell gefährdeter Personen stellt ein ungelöstes Problem dar. Leider erlaubt das Muster der frühen Repolarisation derzeit keine Risikoabschätzung. Insbesondere die Frage einer prophylaktischen ICD-Implantation kann nur vom Einzelfall abhängig gemacht werden. Das Konzept einer Repolarisationsreserve für das Long-QT-Syndrom ist auf die frühe Repolarisation übertragbar. Neben einem genetischen Hintergrund spielen hier insbesondere Faktoren wie das autonome Nervensystem, das Geschlecht, aber im Einzelfall vermutlich auch ein akute Ischämie eine Rolle. Ähnlich wie beim Long-QT-Syndrom ist es vorstellbar, dass auch hier erst durch das Zusammenspiel verschiedener Faktoren eine Schwelle für das Auftreten von Kammerflimmern überschritten wird. Der Übergang von benignen inferolateralen Zeichen einer frühen Repolarisation zu ausgedehnten frühen Repolarisationsveränderungen folgt dabei keinem Alles-oder-nichts-Gesetz. Kommen zu den EKG-Veränderungen, die für sich alleine genommen i. d. R. gutartig sind, besondere Trigger hinzu, kann eine elektrische Katastrophe entstehen, die zum Auftreten eines plötzlichen Herztodes führt.

Abstract

Early repolarization, involving infero-lateral ST segment elevation and prominent J waves at the QRS-ST junction has been considered a normal ECG variant for more than 80 years. More recent studies suggest that this phenomenon is not as benign as earlier believed and may represent a risk for subsequent ventricular fibrillation in patients with and without structural heart disease. However, based on current data it seems unjustified to consider these often accidental ECG findings a marker for high risk of sudden cardiac death. The concept of a reduced repolarization reserve developed for the Long QT syndrome can be transformed to early repolarization syndrome. In general a “fibrillation reserve” is relatively high but if triggers such as a genetic background, age, gender, influences of the autonomous nervous system, changes in body temperature, or an acute coronary syndrome act together ventricular fibrillation may occur. A combination of an “early repolarization ECG” with syncope and/or a positive family history of sudden cardiac death may justify defibrillator therapy just on an individual basis. This review intends to summarize actual aspects of early repolarizations syndrome and focuses on the dilemma of risk stratification.

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Authors and Affiliations

  1. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland

    Kristina Wasmer MD, Julia Köbe MD, Peter Milberg MD & Gerold Mönnig MD

  2. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, D-48149, Münster, Deutschland

    Lars Eckardt MD

Authors
  1. Lars Eckardt MD
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  2. Kristina Wasmer MD
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  3. Julia Köbe MD
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  4. Peter Milberg MD
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  5. Gerold Mönnig MD
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Correspondence to Lars Eckardt MD.

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Eckardt, L., Wasmer, K., Köbe, J. et al. Frühe Repolarisation. Herzschr Elektrophys 24, 115–122 (2013). https://doi.org/10.1007/s00399-013-0270-x

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