Abstract
Early repolarization (ER) pattern has been recognized for several decades and was interpreted as a variant of the normal electrocardiogram (ECG) as it was frequently observed in young healthy subjects or athletes. It is characterized by a J point elevation and ST-segment elevation inscribed as a QRS slurring or a notch of the S wave in the inferior leads or/and the lateral leads. The ER pattern has been the subject of increased interest since the report of its higher prevalence in subjects resuscitated from cardiac arrest related to idiopathic ventricular fibrillation (VF). Furthermore, population-based studies showed in healthy young adults that ER pattern was associated with an increased cardiovascular mortality and total mortality. A relationship between ER pattern and malignant arrhythmias is also supported by the experimental work of Antzelevitch et al. which provided the cellular and ionic basis for the J point elevation and its arrhythmogenic potential. The ER pattern may coexist with a number of cardiac or extracardiac conditions such as hypothermia. But this review will focus attention on the “isolated ER pattern” in healthy individuals. Antzelevitch and Yan proposed because of a number of similarities between the “ER syndrome” and the Brugada syndrome to group both syndromes under the heading of “J wave syndromes”. The management of ER syndrome (associated with idiopathic VF) is clearly the insertion of an implantable cardioverter defibrillator (ICD). The ER pattern associated with symptoms such as syncope or a familial history of sudden cardiac death requires a complete work-up. Caution should be raised not to generate anxiety in the subject with asymptomatic “isolated ER pattern” as the odds of developing malignant ventricular arrhythmias or to suffer sudden death in this case are extremely low.
Similar content being viewed by others
References
Littman, D. (1946). Persistence of the juvenile pattern in precordial leads of healthy adult Negroes with a report of electrocardiographic survey on 300 Negro and 200 White subjects. American Heart Journal, 32, 370.
Osborn, J. J. (1953). Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. American Journal of Physiology, 175, 389–398.
Onat, A., Uyanik, A., & Ersanli, O. (1966). A clinical appraisal of the diagnostic significance of “peri-infarction block”. Diseases of the Chest, 49, 600–609.
Klatsky, A. L., Oehm, R., Cooper, R. A., Udaltsova, N., & Armstrong, M. A. (2003). The early repolarization normal variant electrocardiogram: correlates and consequences. The American Journal of Medicine, 15(115), 171–177.
Aizawa, Y., Tamura, M., Chinushi, M., Naitoh, N., Uchiyama, H., Kusano, Y., et al. (1993). Idiopathic ventricular fibrillation and bradycardia-dependent intraventricular block. American Heart Journal, 126, 1473–1474.
Garg, A., Finneran, W., & Feld, G. K. (1998). Familial sudden cardiac death associated with a terminal QRS abnormality on surface 12-lead electrocardiogram in the index case. Journal of Cardiovascular Electrophysiology, 9, 642–647.
Takagi, M., Alhara, N., Takaki, H., et al. (2000). Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease with J wave and ST-segment elevation in inferior leads. Journal of Cardiovascular Electrophysiology, 11, 844–848.
Kalla, H., Yan, G. X., & Marinchak, R. (2000). Ventricular fibrillation in a patient with prominent J (Osborn) waves and ST segment elevation in the inferior electrocardiographic leads: a Brugada syndrome variant? Journal of Cardiovascular Electrophysiology, 11, 95–98.
Yan, G. X., & Antzelevitch, C. (1996). Cellular basis for the electrocardiographic J wave. Circulation, 93, 372–379.
Gussak, I., & Antzelevitch, C. (2000). Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. Journal of Electrocardiology, 33, 299–309.
Antzelevitch, C., & Yan, G. X. (2010). J wave syndromes. Heart Rhythm, 7, 549–558.
Haissaguerre et al. (2007). Third Annual Congress of the European Cardiac Arrhythmia Society, June 3–5, 2007 (Abstract).
Haissaguerre, M., Derval, N., & Sacher, F. (2008). Sudden cardiac arrest associated with early repolarization. The New England Journal of Medicine, 8(358), 2016–2023.
Tikkanen, J. T., Anttonen, O., Junttila, J., et al. (2009). Long-term outcome associated with early repolarization on electrocardiography. The New England Journal of Medicine, 361, 2529–2537.
Sinner, M. F., Reinhard, W., Müller, M., et al. (2010). Association of early repolarization pattern on ecg with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Medicine, 7, e1000314.
Littmann, L. (2010). Early repolarization on electrocardiography. The New England Journal of Medicine, 362, 1148.
Gussak, I., George, S., Bojovic, B., & Vadjic, B. (2008). ECG phenomena of the early ventricular repolarization syndrome in the 21 century. Indian Pacing Electrophysiology Journal, 8, 149–157.
Ghosh, S., Cooper, D. H., Vijayakumar, M. S., et al. (2010). Early repolarization associated with sudden cardiac death: Insights from noninvasive electrocardiographic imaging. Heart Rhythm, 7, 534–537.
Nam, G. B., Kim, Y. H., & Antzelevitch, C. (2008). Augmentation of J waves and electrical storm in patients with early repolarization. The New England Journal of Medicine, 358, 2016–2023.
Rosso, R., Kogan, E., Belhassen, B., et al. (2008). J point elevation in survivors of primary ventricular fibrillation and matched control subjects. Journal of the American College of Cardiology, 52, 1231–1238.
Wellens, H. (2008). Early repolarization revisited. The New England Journal of Medicine, 358, 2063–2064.
Wasserburger, R. H. (1961). The normal RS-T segment elevation variant. The American Journal of Cardiology, 8, 184–192.
Goldman, M. J. (1953). RS-T segment elevation in mid and left precordial leads as a normal variant. American Heart Journal, 46, 817–820.
Cappato, R., Furlanello, F., Giovinazzo, V., et al. (2010). J wave, QRS slurring and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker risk or recent bystander? Circulation. Arrhythmia and Electrophysiology, 3, 305–311.
Wilhem, M., Brem, M. H., Rost, C., et al. (2010). Early repolarization, left ventricular diastolic function and left atrial size in professional soccer players. The American Journal of Cardiology, 106, 569–574.
Kaneko, Y., Nakajima, T., Irie, T., & Kurabayashi, M. (2010). Augmentation of the J wave following ventricular pause in “benign” early repolarization. Internal Medicine, 49, 1671.
Brugada, P., & Brugada, J. (1992). Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. Journal of the American College of Cardiology, 15, 20(6), 1391–1396.
Qi, X., Sun, F., An, X., & Jang, J. (2004). A case of Brugada syndrome with ST segment elevation through entire precordial leads. Chinese Journal of Cardiology, 32, 272–273.
Burashnikov, A., Pfeifer, R., Borgreffe, M., et al. (2009). Mutations of the cardiac L type calcium channel associated with inherited sudden cardiac death syndromes. Circulation, 20, 93–98.
Haissaguerre, M., Shoda, M., Jais, P., et al. (2002). Mapping and ablation of idiopathic ventricular fibrillation. Circulation, 106, 962–967.
Haïssaguerre, M., Sacher, F., Nogami, A., et al. (2009). Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. Journal of the American College of Cardiology, 53, 612–619.
Watanabe, H., Makiyama, T., Koyama, T., et al. (2010). High prevalence of early repolarization in short QT syndrome. Heart Rhythm, 7, 647–652.
Viskin, S. (2009). Idiopathic ventricular fibrillation “Le syndrome d’Haissaguerre” and the fear of the J waves. Journal of the American College of Cardiology, 53, 620–622.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lévy, S., Sbragia, P. ECG repolarization syndrome abnormalities (J wave syndromes) and idiopathic ventricular fibrillation. J Interv Card Electrophysiol 32, 181–186 (2011). https://doi.org/10.1007/s10840-011-9597-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-011-9597-6