Cardiovascular Medicine Book




Early Repolarization

Aka: Early Repolarization, Benign Early Repolarization, J Point Elevation, J-Point Elevation
  1. See Also
    1. ST Elevation
    2. J Wave Syndrome
  2. Epidemiology
    1. Prevalence: 5% of general population
    2. Most common in healthy young patients under age 50 years old
  3. Risk Factors
    1. Young men
    2. African american
    3. Athletes
    4. Bradycardia
  4. Signs
    1. Characteristics
      1. ST segment elevation with a concave upwards appearance (Smiley appearance) in V2-V5
        1. ST Elevation < 2 mm in precordial leads (may be up to 5 mm in atypical cases)
        2. ST Elevation <0.5 mm in limb leads
      2. Contrast with acute coronary events
        1. Convex upwards appearance (Frown appearance) of an acute coronary event
        2. No reciprocal ST depression (aVR is the exception)
    2. Distribution
      1. Widespread across precordial leads (especially V2 to V5)
    3. Asociated findings
      1. J Wave
        1. Notch or slurring at the end of the QRS Complex
      2. T Waves
        1. Prominent T Waves that are concordant with the QRS
        2. ST segment elevation is <25% the height of the T Wave (leads V4-6, lead I)
  5. Precautions: Red Flags
    1. Reciprocal ST depression
      1. Casts doubt on Early Repolarization as cause of ST Elevation
      2. Suggests coronary cause of ST Elevation
  6. Interpretation: Studies with mixed results on prognosis
    1. Early Repolarization has been long considered a benign finding until 2008
    2. Brugada Syndrome and Early Repolarization Syndrome are both J Wave Syndromes
    3. Studies in 2008 suggested possible connection between Early Repolarization and sudden Cardiac Arrest
      1. If risk is increased it appears to manifest in the longterm (5-30 years of follow-up)
      2. Haissaguerre (2008) N Engl J Med 358(19): 2016-23 [PubMed]
    4. Large study in 2011 showed no increased risk of Sudden Cardiac Death
      1. However, study sample was skewed to older, white patients
      2. More typical cohort of concern would be younger african american patients described above under risk factors
      3. Uberoi (2011) Circulation 124(20): 2208-14 [PubMed]
  7. Prognosis
    1. If Early Repolarization increases Sudden Cardiac Death, the risk is a longterm risk (over as much as 30 years)
      1. Manage emergency department patients based on their presenting symptoms (e.g. Syncope)
      2. Asymptomatic Early Repolarization incidently found on EKG can be addressed on a routine basis
        1. Aggressive measures (e.g. AICD) are not indicated in asymptomatic patients
    2. Early Repolarization associated risk of idiopathic Ventricular Fibrillation or early cardiac death
      1. Associated with 4-10 fold increased risk of Sudden Cardiac Death (10 year risk)
      2. Incidence overall: 3.4 per 100,000
      3. Incidence if J Wave present (esp. >2mm in inferior leads): 11 per 100,000
      4. Benito (2010) J Am Coll Cardiol 56(15): 1177-86 [PubMed]
  8. References
    1. Krishnan (2018) Cardiac Arrhythmias Conference, UMN, Minneapolis
    2. Mattu and Herbert in Majoewsky (2012) EM:RAP 12(3): 4
    3. Grauer (2001) 12 Lead EKGs, 2nd ed, KG/EKG Press, Gainesville, Florida

Early repolarization (C1997354)

Definition (NCI_CDISC) An electrocardiographic finding of J point and ST segment elevation in the absence of other signs of acute ischemia or pericarditis.
Definition (NCI) An electrocardiographic finding of J point and ST segment elevation in the absence of other signs of acute ischemia or pericarditis. (CDISC)
Concepts Finding (T033)
SnomedCT 428417006
English Early repolarization (finding), ERP, Early Ventricular Repolarization, Early Repolarization Pattern, Early Repolarization, Early repolarization, EARLY REPOLARIZATION
Spanish repolarización temprana (hallazgo), repolarización temprana
Derived from the NIH UMLS (Unified Medical Language System)

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