Recurrent ST segment elevations in a patient with asymptomatic early repolarization during head and neck surgery: implications of vasospastic angina

A 57-year-old woman scheduled for cochlear implant removal exhibited preoperative electrocardiographic findings of early repolarization (ER). Four episodes of transient ST segment elevations during surgery raised suspicion for vasospastic angina (VA). In the post-anesthetic care unit, the patient complained of chest discomfort and received sublingual nitroglycerin with uncertain effect. The patient refused to proceed with postoperative invasive coronary angiography, resulting in inconclusive diagnosis. Intraoperative circumstances limit the diagnosis of VA, which emphasizes the need for further testing to confirm the diagnosis. When VA is suspected in patients with underlying ER, it is reasonable to consider invasive examination to establish the diagnosis and prevent recurrence of VA. If ST changes are observed during surgery in patients with preoperative ER, careful monitoring is recommended. Due to general anesthesia, the absence of patient symptoms limits the definitive diagnosis of those with suspected VA. Therefore, additional postoperative surveillance is recommended.

High Prevalence and Clinical Implication of Myocardial Bridging in Patients with Early Repolarization

PURPOSE: Recent evidence suggests that early repolarization (ER) is related with myocardial ischemia. Compression of coronary artery by a myocardial bridging (MB) can be associated with clinical manifestations of myocardial ischemia. This study aimed to evaluate the associations of MB in patients with ER. MATERIALS AND METHODS: In consecutive patients (n=1303, age, 61±12 years) who had undergone coronary angiography, we assessed the prevalence and prognostic implication of MB in those with ER (n=142) and those without ER (n=1161). RESULTS: MB was observed in 54 (38%) and 196 (17%) patients in ER and no-ER groups (p<0.001). In multivariate analysis, MB was independently associated with ER (odd ratio: 2.9, 95% confidence interval: 1.98–4.24, p<0.001). Notched type ER was more frequently observed in MB involving the mid portion of left anterior descending coronary artery (LAD) (69.8% vs. 30.2%, p=0.03). Cardiac event was observed in nine (6.3%) and 22 (1.9%) subjects with and without ER, respectively. MB was more frequently observed in sudden death patients with ER (2 out of 9, 22%) than in those without ER (0 out of 22). CONCLUSION: MB was independently associated with ER in patients without out structural heart disease who underwent coronary angiography. Notched type ER was closely related with MB involving the mid portion of the LAD. Among patients who had experienced cardiac events, a higher prevalence of MB was observed in patients with ER than those without ER. Further prospective studies on the prognosis of MB in ER patients are required.

La repolarización precoz en el electrocardiograma del futbolista: Prevalencia, características y evolución

La repolarización precoz (RP) en el electrocardiograma (ECG) del deportista ha sido considerada un hallazgo benigno. Algunas publicaciones la han asociado a incremento de riesgo de muerte súbita. Los objetivos del presente trabajo fueron evaluar la prevalencia de RP inferolateral en una población de futbolistas entrenados, describir variables asociadas a esta patente e investigar la aparición de eventos en el seguimiento. Se analizaron ECG de futbolistas sin antecedentes personales y familiares de cardiopatía, con examen físico cardiovascular normal. Se consideró RP a la elevación del punto J ≥ 0.1 mV sobre la línea de base en, al menos, 2 derivaciones inferiores y/o precordiales laterales, asociada o no a deflexión positiva o muesca en la parte final del QRS. Se relacionaron con RP el voltaje de R en V5 o V6, el intervalo PR, la frecuencia cardíaca (FC) y la edad. Fueron contactados a los 60±5 meses de la evaluación inicial con ECG. Estadística: chi cuadrado y test t para datos no apareados. Fueron evaluados 210 ECG de futbolistas hombres, de origen europeo-sudamericano, con entrenamiento de alta intensidad. Edad: 18 ±4.6 años. La RP se encontró en 86 ECG (40.9%), incluida el subtipo inferior en 17 (8.1%). Un ECG mostró RP en cara inferior en forma aislada. Los futbolistas con RP tuvieron mayor edad, menor FC, PR más prolongado y menor voltaje de R. Ninguno de los futbolistas presentó eventos cardiovasculares a los 5 años de la evaluación.

Early repolarization (RP) on the electrocardiogram (ECG) of the athlete has been considered a benign finding. In some publications it has been associated with increased risk of sudden death. The objectives of this study were to evaluate the prevalence of infero-lateral RP in a population of trained players, to describe variables associated with this pattern and investigate the occurrence of events in the follow up. ECG of players with a normal cardiovascular physical examination and without family and personal history of heart disease, were analyzed. RP was considered the J-point elevation ≥ 0.1 mV over baseline in at least 2 inferior and / or lateral precordial leads, associated or not with positive deflection or notch in the end of the QRS. RP is related to the voltage of R in V5 or V6, the PR interval, heart rate (HR) and age. They were contacted at 60 ± 5 months after the initial assessment ECG. Statistics: chi square and t test for unpaired data. We evaluated ECG of 210 soccer players, of European-South American origin, with high intensity training. Age: 18 ± 4.6 years. The RP ECG was present in 86 (40.9%), including the lower subtype in 17 (8.1%). One ECG showed PR in lower face in isolation. RP footballers were older, with less FC, prolonged PR and lower voltage of R. None of the players presented cardiovascular events in a 5 years follow up after this evaluation.

Early Repolarization Syndrome with Idiopathic Ventricular Fibrillation / 이화의대지

Early repolarization is a common electrocardiographic (ECG) feature found in young adults, men and athletes, and has been considered to be a benign feature for the last several decades. But recent studies suggest that early repolarization may be related to idiopathic ventricular fibrillation and sudden cardiac death. We report a young man, 35 years old, who had life threatening ventricular fibrillation and sudden cardiac arrest. He was evaluated for cardiac causes of ventricular fibrillation. There was no explanation other than that his ECG showed an early repolarization pattern so we treated him with implantable cardioverter defibrillator. Thus, we suggest that early repolarization may be related with life threatening ventricular arrhythmia.

Síndromes de la onda J / J wave syndromes

Se realizó una revisión sobre los aspectos más novedosos y polémicos de los síndromes de la onda J, que incluyó el síndrome de repolarización precoz, la fibrilación ventricular idiopática y la muerte súbita nocturna inexplicable. Se enfatiza en las características electrocardiográficas de estos síndromes donde se destaca la presencia de un supradesnivel del ST tipo cóncavo con melladuras o empastamiento del mismo. Se profundiza en las bases genéticas, a veces común a todos ellos, en particular la mutación SCN5A asociada con el supradesnivel del ST y más recientemente la mutación S422L-KCNJ8 como causa de alteración de los canales I K-ATP, lo cual se asocia con mortalidad arrítmica cardíaca. Se concluye que aunque no todos los pacientes con este síndrome estén en riesgo de eventos arrítmicos o de muerte súbita cardíaca, existe un grupo de ellos no despreciable que sí lo están, por lo que el gran desafío de la comunidad médica es desarrollar mejores estrategias de estratificación de riesgo y desarrollar tratamientos más seguros y eficaces para estos

A review was conducted of the newest and most controversial aspects of J wave syndromes, including early repolarization syndrome, idiopathic ventricular fibrillation and sudden unexplained nocturnal death. Emphasis is made on the ECG features of these syndromes, among them the presence of an upwardly concave ST irregularity with notching or slurring. A detailed analysis is made of genetic bases, which are sometimes common to all syndromes, particularly the SCN5A mutation, associated with the ST upwardly irregularity, and more recently the S422L-KCNJ8 mutation causing the alteration in the lK-ATP channels, associated with arrhythmic cardiac mortality. It is concluded that not all patients with this syndrome are at risk of arrhythmic events or sudden cardiac death, but a significant number of them are. Therefore, a great challenge for the medical community is to develop better risk stratification strategies as well as safer and more effective treatments

Electrocardiographic characteristics analvsis on 106 cases with early repolarization variant / 中国综合临床

ObjectiveTo investigate the electrocardiogram (ECG) characteristics of patients with early repolarization variant (ERV).Methods One hundred and six patients diagnosed of ERV based on clinical and ECG and the healthy control group of 100 patients were analyzed and ECG features and ERV site were compared between these two groups.Results The mean heart rate( [ 68.6 ± 8.4 ] beats/min vs [ 74.8 ± 12.6 ]beats/min),QRS time( [95 ± 10] ms,[96 ± 11] ms vs[ 388 ± 12 ] ms,[379 ± 14]ms),QT dispersion and Tp-Te ( [ 80.4 ± 7.6 ] ms vs [ 78.5 ± 8.3 ] ms) were compared respectively between ERV group and control group and there was no significant difference (P ＞ 0.05).The occurrence of J wave in inferior leads was 67.9％,15.1％for the side wall leads,and 17.0％ for the chest leads,thus inferior wall leads had higher incidence than other hads relativelv in ERV ( P ＜ 0.01 ).Conclusion ERV exhibits more occurrence in inferior wall leads.

Correlation study of electrocardiography and risk stratification in patients with early repolarization syndrome / 中国医师进修杂志

Objective To explore the value of electrocardiagraphy and risk stratification in patients with early repolarization syndrome( ERS ). Methods All of 271 eases were divided into three groups: 7 ERS patients with cardiac events (syncope,clinical sudden death or incompleted, ventricular fibrillation and induced ventricular fibrillation during electrophysiological), 82 ERS patients without cardiac events, and 182 cases without heart disease who were matched for age and sex. QRS interval,Tpeak-Tend (TpTe) interval,corrected QT interval(QTc) and QT deviation degree (QTd) in surface ECG were compared among the three groups. Results TpTe interval in ERS patients with cardiac events was significantly longer than that in ERS patients without cardiac events and the control subjects [ ( 123.3±22.4 ) ms vs (87.7±15.5 ) ms; ( 123.3±22.4) ms vs (83.5±15.1 ) ms, P < 0.05 ]. There was no significant difference in QRS interval, QTc and QTd among three groups. Conclusion TpTe interval in ECG might be useful in risk stratification with ERS, but further research is needed.

Preliminary study of relationship between early repolarization syndrome and left ventricular fibromuscular bands / 中华超声影像学杂志

0.05). In comparing the proportions of positions,there was a significant difference between two groups (P