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Sudden Cardiac Arrest Associated with Early Repolarization
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., de Ferranti, S. D., Floyd, J., Fornage, M., Gillespie, C., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000485 · Cited by 12,591
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Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300
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Metadata
- 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)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- 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
- bronze
- doi.org
- 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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