Elsevier

Heart Rhythm

Volume 9, Issue 2, February 2012, Pages 225-229
Heart Rhythm

Clinical
Genetic
Distinguishing “benign” from “malignant early repolarization”: The value of the ST-segment morphology

https://doi.org/10.1016/j.hrthm.2011.09.012Get rights and content

Background

Means for distinguishing the very common “benign early repolarization” from the very rare but malignant form are needed. Recently, the presence of early repolarization with “horizontal ST segment” was found to predict arrhythmic death during long-term follow-up in a large population study. We therefore speculated that the combination of “J waves with horizontal ST segment” would correlate with a history of idiopathic ventricular fibrillation (VF) better than the mere presence of J waves.

Objectives

To determine whether the morphology of the ST segment adds diagnostic value to the mere presence of J waves in a case–control series of idiopathic VF.

Methods

We reanalyzed our case–control study showing that the presence of J waves strongly correlates with a history of idiopathic VF among 45 patients with this disorder, 124 controls matched for age and gender (“matched-control” group), and 121 young athletes. This time we focused only on those patients with J waves and graded their ST-segment morphology as either “horizontal” or “ascending” according to predefined criteria.

Results

The presence of J waves was associated with a history of idiopathic VF with an odds ratio of 4.0 (95% confidence intervals = 2.0–7.9), but having both J waves and horizontal ST segment yielded an odds ratio of 13.8 (95% confidence intervals = 5.1–37.2) for having idiopathic VF.

Conclusions

We report, for the first time, that the combination of J waves with horizontal/descending ST segment improved our ability to distinguish patients with idiopathic VF from controls matched by gender and age.

Section snippets

Methods

Our study population was recently described in detail.13 It consisted of 45 patients with idiopathic VF (aged 14–69 years, mean age 38 ± 15 years; 71% males), a “matched-control group” consisting of 124 healthy individuals matched by age and gender to the idiopathic VF patients, and an “athletes group” of 121 noncompetitive athletes (aged 17–19 years, 50% males) from a preparticipation medical screening program. “J-point elevation” or “J waves” were defined as positive “humplike” deflections

Results

As previously reported,13 J waves were more prevalent among patients with idiopathic VF than among age- and gender-matched controls (42% vs 13%; P <.001) or among young athletes (42% vs 22%; P = .013). J waves were more prevalent among males, and this was true for idiopathic VF patients as well as for controls (Table 1). However, once J waves were present, gender had no statistically significant effect on the contour of the ST segment (Table 1) and the only characteristic associated with J

Discussion

Early repolarization is a common ECG finding, with a prevalence ranging from 6% to 24% in population-based studies.16, 17, 18, 19 Moreover, series including 1000 athletes or more report that as many as 40% of healthy athletes have early repolarization.21 On the other hand, this finding has been strongly associated with idiopathic VF,12, 13, 14, 15, 25 a rare but highly lethal disease.26 Therefore, diagnostic tools capable of distinguishing the very common “benign early repolarization” from the

References (45)

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Raphael Rosso and Eran Glikson contributed equally to this manuscript.

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