Impact of Ethnicity on the Prevalence of Early Repolarization Pattern in Children: Comparison Between Caucasian and African Populations
The patterns and prevalence of early repolarization pattern (ER) in pediatric populations from ethnic backgrounds other than Caucasian have not been determined. Black African children (ages 4–12) from north-west Madagascar were prospectively recruited and their ECGs compared with those of age- and sex-matched Caucasian ethnicity individuals. ER was defined by ≥ 0.1 mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. A total of 616 children were included. There was a trend toward a higher frequency of ER in the Africans compared to the Caucasians (23.3% vs. 17.1%, respectively, p = 0.053). The subtype (slurred vs. notched) and location of ER (lateral, inferior, or inferior-lateral) were significantly different in the two groups (p < 0.001 and p = 0.020, respectively). There was no significant difference in the number of high-risk ECG features of ERP (i.e., horizontal/descendent pattern, inferior or inferior-lateral location or J-waves ≥ 2 mm) between African and Caucasian children. On the multivariate analysis, African ethnicity was an independent predictive factor of ER (OR 3.57, 95% CI 2.04–6.25, p < 0.001). African children have an increased risk of ER compared to Caucasian counterparts. Future studies should clarify the clinical and prognostic significance of ER in the pediatric population, and whether ethnicity has an impact on the outcomes.
KeywordsEarly repolarization Ethnicity Sudden death Pediatrics
AC designed and directed this study, drafted the manuscript, and participated in data collection, analysis and interpretation. MA participated in data collection and interpretation, and critically revised the manuscript. RL participated in data collection, analysis, and interpretation. FQ and GDG participated in data collection, and analysis. MF, VA, RB, DC, ACru, SDB, RG, US, GM, DS, MC, and GM participated in data collection. RP performed statistics and critically revised the article. PDL, PC, and AP critically revised the manuscript. All the authors approved the final version of the manuscript.
Compliance with Ethical Standards
Conflict of interest
Authors have no conflicts of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Rautaharju PM, Surawicz B, Gettes LS (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electro-cardiogram, part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Circulation 119:e241–e250CrossRefGoogle Scholar
- 11.Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D, Halkin A, Steinvil A, Heller K, Glikson M, Katz A, Viskin S (2008) J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 52:1231–1238CrossRefGoogle Scholar
- 15.Sinner MF, Reinhard W, Müller M, Beckmann BM, Martens E, Perz S, Pfeufer A, Winogradow J, Stark K, Meisinger C, Wichmann HE, Peters A, Riegger GA, Steinbeck G, Hengstenberg C, Kääb S (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 Med 7:e1000314CrossRefGoogle Scholar
- 16.Walsh JA III, Prineas R, Daviglus ML, Ning H, Liu K, Lewis CE, Sidney S, Schreiner PJ, Iribarren C, Lloyd-Jones DM (2010). Prevalence of electrocardiographic abnormalities in a middle-aged, biracial population: coronary artery risk development in young adults study. J Electrocardiol 43:e381ee389CrossRefGoogle Scholar
- 20.Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM (2017) J-Wave syndromes expert consensus conference report: emerging concepts and gaps in knowledge. Europace 19:665–694PubMedGoogle Scholar
- 23.Di Gioia G, Creta A, Fittipaldi M, Giorgino R, Quintarelli F, Satriano U, Cruciani A, Antinolfi V, Di Berardino S, Costanzo D, Bettini R, Mangiameli G, Caricato M, Mottini G (2016) Effects of malnutrition on left ventricular mass in a North-Malagasy children population. PLoS ONE 11:e0154523CrossRefGoogle Scholar