Cited by 1,449Cardiac electrophysiology and arrhythmiasCardiovascular Effects of ExerciseCardiac pacing and defibrillation studies

Sudden Cardiac Arrest Associated with Early Repolarization

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Haïssaguerre, Michel, Derval, Nicolas, Sacher, Frederic, Jesel, Laurence, Deisenhofer, Isabel, de Roy, Luc, Pasquié, Jean-Luc, Nogami, Akihiko +29 more·2008·New England Journal of Medicine

Abstract

BACKGROUND: Early repolarization is a common electrocardiographic finding that is generally considered to be benign. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is not known whether there is a clinical association with sudden cardiac arrest. METHODS: We reviewed data from 206 case subjects at 22 centers who were resuscitated after cardiac arrest due to idiopathic ventricular fibrillation and assessed the prevalence of electrocardiographic early repolarization. The latter was defined as an elevation of the QRS-ST junction of at least 0.1 mV from baseline in the inferior or lateral lead, manifested as QRS slurring or notching. The control group comprised 412 subjects without heart disease who were matched for age, sex, race, and level of physical activity. Follow-up data that included the results of monitoring with an implantable defibrillator were obtained for all case subjects. RESULTS: Early repolarization was more frequent in case subjects with idiopathic ventricular fibrillation than in control subjects (31% vs. 5%, P<0.001). Among case subjects, those with early repolarization were more likely to be male and to have a history of syncope or sudden cardiac arrest during sleep than those without early repolarization. In eight subjects, the origin of ectopy that initiated ventricular arrhythmias was mapped to sites concordant with the localization of repolarization abnormalities. During a mean (+/-SD) follow-up of 61+/-50 months, defibrillator monitoring showed a higher incidence of recurrent ventricular fibrillation in case subjects with a repolarization abnormality than in those without such an abnormality (hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.5; P=0.008). CONCLUSIONS: Among patients with a history of idiopathic ventricular fibrillation, there is an increased prevalence of early repolarization.

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Crossref · 10.1056/nejmoa071968

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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 [352]

    The Study Population section defines early repolarization as at least 1 mm of J-point elevation in inferior or lateral leads. The Early Repolarization section reports it in 64 of 206 idiopathic ventricular fibrillation cases (31%), which falls within the claimed range, but the paper does not establish the 15% or 70% endpoints. (LLM, conf=0.85)

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  • Early 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 [352]

    The introduction (section “S”; page unavailable) says early repolarization affects 1–5% of persons, and the Early Repolarization results report it in 5% of matched controls. The Study Population section defines the pattern as at least 1 mm of J-point elevation in inferior or lateral leads. Our copy does not support the claimed upper prevalence of 13% in the general population. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Early repolarization pattern is associated with increased risk of cardiac death in population-based studies.

    “Furthermore, it has been shown in population-based studies to be associated with increased risk of cardiac death (352,353,355–357).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [352]

    The Abstract reports that early repolarization was more frequent among people resuscitated after idiopathic ventricular fibrillation than among matched controls, supporting an association with sudden cardiac arrest. The study was not population-based and did not establish an increased risk of cardiac death in the general population; the Discussion also says its findings require confirmation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 5

  1. Viskin S, Belhassen B. Idiopathic ven- tricular fibrillation. Am Heart J 1990; 120:661-71.
  2. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-seg- ment elevation in leads V1 through V3: a marker for sudden death in patients with- out demonstrable structural heart dis- ease. Circulation 1998;97:457-60.
  3. Mehta M, Jain AC, Mehta A. Early re- polarization. Clin Cardiol 1999;22:59-65.
  4. Gussak I, Antzelevitch C. Early repo- larization syndrome: clinical characteris- tics and possible cellular and ionic mech- anisms. J Electrocardiol 2000;33:299-309.
  5. ment elevation in the inferior electrocar- diographic leads: a Brugada syndrome variant? J Cardiovasc Electrophysiol 2000; 11:95-8.

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Authors
Haïssaguerre, M., Derval, N., Sacher, F., Jesel, L., Deisenhofer, I., de Roy, L., Pasquié, J.-L., Nogami, A., Babuty, D., Yli-Mayry, S., De Chillou, C., Scanu, P., Mabo, P., Matsuo, S., Probst, V., Le Scouarnec, S., Defaye, P., Schlaepfer, J., Rostock, T., Lacroix, D., Lamaison, D., Lavergne, T., Aizawa, Y., Englund, A., Anselme, F., O'Neill, M., Hocini, M., Lim, K. T., Knecht, S., Veenhuyzen, G. D., Bordachar, P., Chauvin, M., Jais, P., Coureau, G., Chene, G., Klein, G. J., & Clémenty, J.
Affiliations
Université de Bordeaux (FR)
Venue
New England Journal of Medicine
Published
2008-05-08
Volume
358
Issue
19
Pages
2016-2023
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2168574959
Cited by
1,449
References
28
Citations by year
2026: 26 · 2025: 36 · 2024: 42 · 2023: 47 · 2022: 49 · 2021: 61 · 2020: 72 · 2019: 74 · 2018: 69 · 2017: 113 · 2016: 123 · 2015: 106 · 2014: 109 · 2013: 141 · 2012: 130
FWCI
60.38
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DIAL (Catholic University of Leuven) (submittedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
  • IRIS (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
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 pacing and defibrillation studies
Keywords
early repolarization, sudden cardiac arrest, idiopathic ventricular fibrillation, QRS notching, recurrent ventricular fibrillation, syncope, ventricular arrhythmias
MeSH terms
Actuarial Analysis, Adult, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Ventricular Fibrillation, Prevalence, Case-Control Studies, Death, Sudden, Cardiac, Catheter Ablation, Defibrillators, Implantable, Statistics, Nonparametric, Cardiac Electrophysiology

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