Prevalence and Characteristics of Early Repolarization in the CASPER Registry
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Objectives We evaluated the prevalence and characteristics of early repolarization in patients in CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). Background Early repolarization has been implicated in a syndrome of polymorphic ventricular tachycardia and fibrillation in patients without organic heart disease. Methods One hundred patients with apparently unexplained cardiac arrest and preserved ejection fraction underwent extensive clinical and genetic testing to unmask subclinical electrical or structural disease. A blinded independent analysis of the 12-lead electrocardiogram (ECG) was performed. Early repolarization was defined as ≥0.1 mV QRS-ST junction (J-point) elevation with terminal QRS slurring or notching in at least 2 contiguous inferior and/or lateral leads. Results One hundred cardiac arrest patients were enrolled (40 females, age 43 ± 14 years). Forty-four were diagnosed with an established cause for cardiac arrest. Significant early repolarization was found in 19 patients, including 6 with a primary diagnosis that explained their cardiac arrest (14%), compared with 23% of the 56 patients with idiopathic ventricular fibrillation (IVF) (p = 0.23). J-point elevation in IVF patients had higher amplitude (0.25 ± 0.11 mV vs. 0.13 ± 0.05 mV, p = 0.02) and wider distribution (4.3 ± 1.3 leads vs. 2.8 ± 0.8 leads; p = 0.01) than those with an established cause of cardiac arrest. J-wave amplitude was fluctuant on serial ECGs; at least 1 ECG failed to demonstrate early repolarization in 58% of patients. Conclusions Early repolarization is present in a significant proportion of causally diagnosed and idiopathic VF. It is often intermittent and more pronounced in IVF patients. (Registry of Unexplained Cardiac Arrest; NCT00292032).
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Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 15% to 70% of idiopathic VF cases.
“Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population and in 15% to 70% of idiopathic VF cases (352–354).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [354]
The Methods define significant early repolarization as at least 0.1 mV (1 mm) of J-wave elevation in inferior and/or lateral leads. The Abstract reports it in 23% of 56 idiopathic VF patients, which falls within the claimed range, but the paper does not establish the full 15%–70% range. (LLM, conf=0.85)
Experimental — accuracy not yet measuredEarly repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population.
“Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population and in 15% to 70% of idiopathic VF cases (352–354).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [354]
The Discussion (page unavailable) reports early repolarization prevalence of 5% to 13% in the general population, supporting the population and upper end of the range but not the claimed 1% lower end. The Methods (page unavailable) define the relevant inferior/lateral pattern using J-wave elevation of ≥0.1 mV (1 mm), rather than strictly >1 mm. (LLM, conf=0.86)
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- Authors
- Derval, N., Simpson, C. S., Birnie, D. H., Healey, J. S., Chauhan, V., Champagne, J., Gardner, M., Sanatani, S., Yee, R., Skanes, A. C., Gula, L. J., Leong-Sit, P., Ahmad, K., Gollob, M. H., Haïssaguerre, M., Klein, G. J., & Krahn, A. D.
- Affiliations
- Centre Hospitalier Universitaire de Bordeaux (FR)
- Queen's University (CA)
- University of Ottawa (CA)
- University Health Network (CA)
- Queen Elizabeth II Health Sciences Centre (CA)
- BC Children's Hospital (CA)
- Western University (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Krahn, Andrew D.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 58
- Issue
- 7
- Pages
- 722-728
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W198842176
- Cited by
- 150
- References
- 8
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 7 · 2017: 16 · 2016: 22 · 2015: 15 · 2014: 17 · 2013: 23 · 2012: 17
- FWCI
- 13.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boston Scientific
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- early repolarization, cardiac arrest survivors, idiopathic ventricular fibrillation, J-point elevation, QRS notching, polymorphic ventricular tachycardia, preserved ejection fraction, subclinical cardiac disease
- MeSH terms
- Adolescent, Adult, Aged, Electrocardiography, Female, Heart Arrest, Humans, Male, Middle Aged, Registries, Stroke Volume, Ventricular Fibrillation, Death, Sudden, Cardiac, Young Adult
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