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Benign Versus Malignant Early Repolarization Patterns

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Cardiac Repolarization

Abstract

Distinguishing the “benign” from the “malignant” patterns of early repolarization is of outmost importance because the former electrocardiogram (ECG) pattern is frequently observed in healthy individuals, whereas the latter, far more rarely, is associated with sudden death from idiopathic ventricular fibrillation (VF). It is important to analyze the three components of the early repolarization ECG pattern, that is, the J-wave proper, the ST-segment, and the ensuing T-waves. T-waves of higher amplitude and longer duration, ST-segments that are horizontal or descending (as opposed to ascending ST-segment), and low-amplitude T-waves correlate with increased risk of idiopathic VF. However, there is too much overlapping between the values of the two groups to allow for reliable diagnosis in the absence of symptoms (except for the rare “monstrous” J-waves).

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References

  1. Viskin S, Rosso R, Halkin A. Making sense of early repolarization. Heart Rhythm. 2012;9(4):566–8.

    Article  Google Scholar 

  2. Rosso R, Adler A, Halkin A, Viskin S. Risk of sudden death among young individuals with J waves and early repolarization: putting the evidence into perspective. Heart Rhythm. 2011;8(6):923–9.

    Article  Google Scholar 

  3. Adler A, Rosso R, Viskin D, Halkin A, Viskin S. What do we know about the “malignant form” of early repolarization? J Am Coll Cardiol. 2013;62(10):863–8.

    Article  Google Scholar 

  4. Ezaki K, Nakagawa M, Taniguchi Y, Nagano Y, Teshima Y, Yufu K, et al. Gender differences in the ST segment: effect of androgen-deprivation therapy and possible role of testosterone. Circ J. 2010;74(11):2448–54.

    Article  Google Scholar 

  5. Walsh JA 3rd, Ilkhanoff L, Soliman EZ, Prineas R, Liu K, Ning H, et al. Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) Study. J Am Coll Cardiol. 2013;61(8):863–9.

    Article  Google Scholar 

  6. Panicker GK, Manohar D, Karnad DR, Salvi V, Kothari S, Lokhandwala Y. Early repolarization and short QT interval in healthy subjects. Heart Rhythm. 2012;9(8):1265–71.

    Article  Google Scholar 

  7. Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T, et al. Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation. 2011;123(23):2666–73.

    Article  Google Scholar 

  8. Noseworthy PA, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, et al. Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training. Circ Arrhythm Electrophysiol. 2011;4(4):432–40.

    Article  Google Scholar 

  9. Perez MV, Uberoi A, Jain NA, Ashley E, Turakhia MP, Froelicher V. The prognostic value of early repolarization with ST-segment elevation in African Americans. Heart Rhythm. 2012;9(4):558–65.

    Article  Google Scholar 

  10. Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358(19):2016–23.

    Article  CAS  Google Scholar 

  11. Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects incidence and clinical significance. J Am Coll Cardiol. 2008;52(15):1231–8.

    Article  Google Scholar 

  12. Kim SH, Kim do Y, Kim HJ, Jung SM, Han SW, Suh SY, et al. Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study. BMC Cardiovasc Disord. 2012;12:122.

    Article  Google Scholar 

  13. Talib AK, Sato N, Asanome A, Myojo T, Nishiura T, Yamaki M, et al. Impaired ventricular repolarization dynamics in patients with early repolarization syndrome. J Cardiovasc Electrophysiol. 2013;24(5):556–61.

    Article  Google Scholar 

  14. Pargaonkar VS, Perez MV, Jindal A, Mathur MB, Myers J, Froelicher VF. Long-term prognosis of early repolarization with J-wave and QRS slur patterns on the resting electrocardiogram: a Cohort Study. Ann Intern Med. 2015;163(10):747–55.

    Article  Google Scholar 

  15. Macfarlane PW, Antzelevitch C, Haissaguerre M, Huikuri HV, Potse M, Rosso R, et al. The early repolarization pattern: a consensus paper. J Am Coll Cardiol. 2015;66(4):470–7.

    Article  Google Scholar 

  16. Surawicz B, Macfarlane PW. Inappropriate and confusing electrocardiographic terms: J-wave syndromes and early repolarization. J Am Coll Cardiol. 2011;57(15):1584–6.

    Article  Google Scholar 

  17. Roten L, Derval N, Maury P, Mahida S, Pascale P, Leenhardt A, et al. Benign vs. malignant inferolateral early repolarization: focus on the T wave. Heart Rhythm. 2016;13(4):894–902.

    Article  Google Scholar 

  18. Viskin S, Havakuk O, Antzelevitch C, Rosso R. Malignant early repolarization: It’s the T-wave, stupid. Heart Rhythm. 2016;13(4):903–4.

    Article  Google Scholar 

  19. Viskin S, Rosso R. J-wave syndromes. In: Zipes DP, Jalife J, Stevenson WG, editors. Cardiac electrophysiology: from cell to bedside. 7th ed: Philadelphia: Elsevier; 2017.

    Chapter  Google Scholar 

  20. Osborn JJ. Experimental hypothermia; respiratory and blood pH changes in relation to cardiac function. Am J Phys. 1953;175(3):389–98.

    Article  CAS  Google Scholar 

  21. Johnson P, Lesage A, Floyd WL, Young WG Jr, Sealy WC. Prevention of ventricular fibrillation during profound hypothermia by quinidine. Ann Surg. 1960;151:490–5.

    Article  CAS  Google Scholar 

  22. Fish JM, Antzelevitch C. Link between hypothermia and the Brugada syndrome. J Cardiovasc Electrophysiol. 2004;15(8):942–4.

    Article  Google Scholar 

  23. Gurabi Z, Koncz I, Patocskai B, Nesterenko VV, Antzelevitch C. Cellular mechanism underlying hypothermia-induced ventricular tachycardia/ventricular fibrillation in the setting of early repolarization and the protective effect of quinidine, cilostazol, and milrinone. Circ Arrhythm Electrophysiol. 2014;7(1):134–42.

    Article  CAS  Google Scholar 

  24. Bastiaenen R, Hedley PL, Christiansen M, Behr ER. Therapeutic hypothermia and ventricular fibrillation storm in early repolarization syndrome. Heart Rhythm. 2010;7(6):832–4.

    Article  Google Scholar 

  25. Federman NJ, Mechulan A, Klein GJ, Krahn AD. Ventricular fibrillation induced by spontaneous hypothermia in a patient with early repolarization syndrome. J Cardiovasc Electrophysiol. 2013;24(5):586–8.

    Article  Google Scholar 

  26. Kanna B, Wani S. Giant J wave on 12-lead electrocardiogram in hypothermia. Ann Noninvasive Electrocardiol. 2003;8(3):262–5.

    Article  Google Scholar 

  27. Cristoforetti Y, Biasco L, Giustetto C, De Backer O, Castagno D, Astegiano P, et al. J-wave duration and slope as potential tools to discriminate between benign and malignant early repolarization. Heart Rhythm. 2016;13(3):806–11.

    Article  Google Scholar 

  28. Aizawa Y, Takatsuki S, Nishiyama T, Kimura T, Kohsaka S, Kaneko Y, et al. Tachycardia-induced J-wave changes in patients with and without idiopathic ventricular fibrillation. Circ Arrhythm Electrophysiol. 2017;10(7):pii:e005214.

    Article  Google Scholar 

  29. Rosso R, Glikson E, Belhassen B, Katz A, Halkin A, Steinvil A, et al. Distinguishing “benign” from “malignant early repolarization”: the value of the ST-segment morphology. Heart Rhythm. 2012;9(2):225–9.

    Article  Google Scholar 

  30. Cappato R, Furlanello F, Giovinazzo V, Infusino T, Lupo P, Pittalis M, et al. J wave, QRS slurring, and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker of risk or innocent bystander? Circ Arrhythm Electrophysiol. 2010;3(4):305–11.

    Article  Google Scholar 

  31. Zhang J, Hocini M, Strom M, Cuculich PS, Cooper DH, Sacher F, et al. The electrophysiological substrate of early repolarization syndrome: noninvasive mapping in patients. JACC Clin Electrophysiol. 2017;3(8):894–904.

    Article  Google Scholar 

  32. Haissaguerre M, et al. Ventricular fibrillation with prominent early repolarization associated with a rare variant of KCNJ8/KATP channel. J Cardiovasc Elecrophysiol. 2009;20:93.

    Article  Google Scholar 

  33. Aizawa Y, et al. Dynamicity of the J-wave in idiopathic ventricular fibrillation with a special reference to pause-dependent augmentation of the J-wave. JACC. 2012;59:1948.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology, Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Raphael Rosso & Sami Viskin

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  1. Raphael Rosso
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  2. Sami Viskin
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Editors and Affiliations

  1. Department of Medicine and Physiology, State University of New York Downstate Medical Center, VA New York Harbor Healthcare Center, Brooklyn, NY, USA

    Nabil El-Sherif

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Rosso, R., Viskin, S. (2020). Benign Versus Malignant Early Repolarization Patterns. In: El-Sherif, N. (eds) Cardiac Repolarization. Springer, Cham. https://doi.org/10.1007/978-3-030-22672-5_16

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  • DOI: https://doi.org/10.1007/978-3-030-22672-5_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22671-8

  • Online ISBN: 978-3-030-22672-5

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