Autonomic Influences Related to Early Repolarization in Patients Without Structural Heart Disease


This cross-sectional study focused on the association between heart rate variability (HRV) and early repolarization pattern (ERP). It included 1236 patients categorized into three groups: ERP type 1: J-point elevation with notched/slurred QRS; ERP type 2: ST elevation without dominant J-wave; and non-ERP group. Analyzing time-domain indexes include standard deviation of NN (normal-to-normal) RR intervals (SDNN), root mean square of successive difference in NN RR intervals (RMSSD), and proportion of consecutive NN intervals that differ by more than 50 ms (PNN50), there were significant differences between any two groups (all P < 0.01). All time-domain indexes showed: ERP type 2 > ERP type 1 > non-ERP. Multivariate logistic regression analysis revealed that SDNN at nighttime and gender were independently associated with the maximum magnitude of J-point elevation ≧ 0.2 mV. The findings strongly suggested that based on electrocardiogram characteristics, parasympathetic tone denoted by HRV may be related to different types of ERP.

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  1. 1.

    Tikkanen, J. T., Anttonen, O., Junttila, M. J., et al. (2009). Long-term outcome associated with early repolarization on electrocardiography [J]. N Engl J Med, 361(26), 2529–2537.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Olson, K. A., Viera, A. J., Soliman, E. Z., et al. (2011). Long-term prognosis associated with J-point elevation in a large middle-aged biracial cohort: the ARIC study [J]. Eur Heart J, 32(24), 3098–3106.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Sinner, M. F., Reinhard, W., Muller, 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) [J]. PLoS Med, 7(7), e1000314.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Uberoi, A., Jain, N. A., Perez, M., et al. (2011). Early repolarization in an ambulatory clinical population [J]. Circulation, 124(20), 2208–2214.

    Article  PubMed  Google Scholar 

  5. 5.

    Haruta, D., Matsuo, K., Tsuneto, A., et al. (2011). Incidence and prognostic value of early repolarization pattern in the 12-lead electrocardiogram [J]. Circulation, 123(25), 2931–2937.

    Article  PubMed  Google Scholar 

  6. 6.

    Junttila, M. J., Tikkanen, J. T., Kentta, T., et al. (2014). Early repolarization as a predictor of arrhythmic and nonarrhythmic cardiac events in middle-aged subjects [J]. Heart Rhythm : the official journal of the Heart Rhythm Society, 11(10), 1701–1706.

    Article  Google Scholar 

  7. 7.

    Wu, S. H., Lin, X. X., Cheng, Y. J., et al. (2013). Early repolarization pattern and risk for arrhythmia death: a meta-analysis [J]. J Am Coll Cardiol, 61(6), 645–650.

    Article  PubMed  Google Scholar 

  8. 8.

    Cheng, Y.-J., Li, Z.-Y., Yao, F.-J., et al. (2017). Early repolarization is associated with a significantly increased risk of ventricular arrhythmias and sudden cardiac death in patients with structural heart diseases [J]. Heart Rhythm : the official journal of the Heart Rhythm Society, 14(8), 1157–1164.

    Article  Google Scholar 

  9. 9.

    Rosso, R., Kogan, E., Belhassen, B., et al. (2008). J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance [J]. J Am Coll Cardiol, 52(15), 1231–1238.

    Article  PubMed  Google Scholar 

  10. 10.

    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 of risk or innocent bystander? [J]. Circ Arrhythm Electrophysiol, 3(4), 305–311.

    Article  PubMed  Google Scholar 

  11. 11.

    Haïssaguerre, M., Derval, N., Sacher, F., et al. (2008). Sudden cardiac arrest associated with early repolarization [J]. N Engl J Med, 358(19), 2016–2023.

    Article  PubMed  Google Scholar 

  12. 12.

    Levy, M. N. (1990). Autonomic interactions in cardiac control. Ann N Y Acad Sci, 601, 209–221.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Draghici, A. E., & Taylor, J. A. (2016). The physiological basis and measurement of heart rate variability in humans. J Physiol Anthropol, 35, 22.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Patton, K. K., Ellinor, P. T., Ezekowitz, M., et al. (2016). Electrocardiographic early repolarization [J]. Circulation, 133(15), 1520–1529.

    Article  PubMed  Google Scholar 

  15. 15.

    Antzelevitch, C., Sicouri, S., Litovsky, S. H., et al. (1991). Heterogeneity within the ventricular wall. Electrophysiology and pharmacology of epicardial, endocardial, and M cells [J]. Circ Res, 69(6), 1427–1449.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Antzelevitch, C., & Yan, G. X. (2011). J-wave syndromes. From cell to bedside [J]. J Electrocardiol, 44(6), 656–661.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Badri, M., Patel, A., & Yan, G. X. (2015). Cellular and ionic basis of J-wave syndromes [J]. Trends Cardiovas Med, 25(1), 12–21.

    CAS  Article  Google Scholar 

  18. 18.

    Shinohara, T., Kondo, H., Otsubo, T., et al. (2017). Exaggerated reactivity of parasympathetic nerves is involved in ventricular fibrillation in J-wave syndrome [J]. J Cardiovasc Electrophysiol, 28(3), 321–326.

    Article  PubMed  Google Scholar 

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The study was financially supported by grants from the National Natural Science Foundation of China (Nos. 81370285 and 81970206), Guangdong Natural Science Foundation (2019A1515010269), and Guangzhou City Science and Technology key Program (No. 201508020057).

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Correspondence to Su-Hua Wu.

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The authors declare that they have no conflict of interest.

Human Subjects/Informed Consent Statement

This study was conducted with the consent of the ethics committee of the first affiliated hospital of Sun Yat-Sen University. It was conducted in accordance with the Helsinki Declaration of 1975 (revised in year 2000). The subjects of this study were 1236 patients treated in the first affiliated hospital of Sun Yat-Sen university between January 2018 and February 2019. All participants provided a written informed consent agreeing to participate in the study.

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Chen, X., Fan, J., Cheng, Y. et al. Autonomic Influences Related to Early Repolarization in Patients Without Structural Heart Disease. J. of Cardiovasc. Trans. Res. (2020).

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  • Early repolarization
  • Heart rate variability
  • Parasympathetic tone