Early Repolarization: When Is It a Normal Pattern?

  • Erika Baiocco
  • Daniele Contadini
  • Alessandro Maolo
  • Maria Vittoria Matassini


Early repolarization (ER) is a common electrocardiographic pattern traditionally considered a benign finding. Recently, studies revealed an association between ER and an increased risk of arrhythmic death. Some clinical and electrocardiographic findings were evaluated with the aim to improve our ability to distinguish “benign” from “malignant early repolarization”. Widespread and high-amplitude J-point elevation followed by a horizontal or descending ST segment has been linked to arrhythmic mortality. Patients with early repolarization and frequent ventricular premature beats (VPBs), syncope or a family history of sudden cardiac death have also higher arrhythmic risks. However, none of these clinical or electrocardiographic findings per se is a valid stratification risk tool. We describe some case report that may enlight this issue.


  1. 1.
    Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The early repolarization pattern: a consensus paper. J Am Coll Cardiol. 2015;66(4):470–7.CrossRefGoogle Scholar
  2. 2.
    Priori SG, Wilde AA, Horie M, et al. Expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10(12):1932–63.CrossRefGoogle Scholar
  3. 3.
    Maury P, Rollin A. Prevalence of early repolarization/J wave patterns in the normal population. J Electrocardiol. 2013;46:411–6.CrossRefGoogle Scholar
  4. 4.
    Noseworthy PA, Tikkanen JT, Porthan K, et al. The early repolarization pattern in the general population: clinical correlates and heritability. J Am Coll Cardiol. 2011;57(22):2284–9.CrossRefGoogle Scholar
  5. 5.
    Tikkanen JT, Junttila MJ, Anttonen O, et al. Early repolarization. Electrocardiographic phenotypes associated with favorable long-term outcome. Circulation. 2011;123:2666–73.CrossRefGoogle Scholar
  6. 6.
    Ben NM, Begg GA, Page SP, et al. Early repolarization syndrome; mechanistic theories and clinical correlates. Front Physiol. 2016;7:266.Google Scholar
  7. 7.
    Antzelevitch C, Yan G, Ackerman MJ, et al. J-wave syndrome expert consensus conference report: emerging concepts and gaps knowledge. J Arrhythmia. 2016;32:315–39.CrossRefGoogle Scholar
  8. 8.
    Haissaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358:2016–23.CrossRefGoogle Scholar
  9. 9.
    Patton KK, Ellinor PT, Ezekowitz M, et al. Electrocardiographic early repolarization. A scientific statement from the America Heart Association. Circulation. 2016;133:1520–9.CrossRefGoogle Scholar
  10. 10.
    Rosso R, Kogan E, Belhassen B, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol. 2008;52:1231–8.CrossRefGoogle Scholar
  11. 11.
    Tikkanen JT, Anttonen O, Junttila MJ, et al. Long-term outcome associated with early repolarization and electrocardiography. N Engl J Med. 2009;361:2529–37.CrossRefGoogle Scholar
  12. 12.
    Rosso R, Glikson E, Belhassen B, et al. Distinguishing “benign” from “malignant early repolarization”: the value of the ST-segment morphology. Heart Rhythm. 2012;9:225–9.CrossRefGoogle Scholar
  13. 13.
    Rizzo C, Monitillo F, Iacoviello M, et al. 12-lead electrocardiogram features of arrhythmic risk: a focus on early repolarization. World J Cardiol. 2016;8(8):447–55.CrossRefGoogle Scholar
  14. 14.
    Saagar M, Derval N, Sacher F, et al. History and clinical significance of early repolarization syndrome. Heart Rhythm. 2015;12(1):242–9.CrossRefGoogle Scholar
  15. 15.
    Aizawa Y, Chinushi M, Hasegawa K, et al. Electrical storm in idiopathic ventricular fibrillation is associated with early repolarization. J Am Coll Cardiol. 2013;62:1015–9.CrossRefGoogle Scholar
  16. 16.
    Watanabe H, Makiyama T, Koyama T, et al. High prevalence of early repolarization in short QT syndrome. Heart Rhythm. 2010;7:647–52.CrossRefGoogle Scholar
  17. 17.
    Tokioka K, Kusano KF, Morita H, et al. Electrocardiographic parameters and fatal arrhythmic events in patients with Brugada syndrome: combination of depolarization and repolarization abnormalities. J Am Coll Cardiol. 2014;63:2131–8.CrossRefGoogle Scholar
  18. 18.
    Tikkanen JT, Huikuri HV, et al. Early repolarization ECG pattern in the Finnish general population. J Electrocardiol. 2013;46:439–41.CrossRefGoogle Scholar
  19. 19.
    Bastiaenen R, Raju H, Sharma S, et al. Characterization of early repolarization during ajmaline provocation and exercise tolerance testing. Heart Rhythm. 2013;10:247–54.CrossRefGoogle Scholar
  20. 20.
    Saagar M, Derval N, Sacher F, et al. Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome. J Am Coll Cardiol. 2015;65:151–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Erika Baiocco
    • 1
  • Daniele Contadini
    • 1
  • Alessandro Maolo
    • 1
  • Maria Vittoria Matassini
    • 1
  1. 1.Clinica di Cardiologia e AritmologiaUniversità Politecnica delle MarcheAnconaItaly

Personalised recommendations