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Early repolarisation syndrome

Oruganti Sai Satish, K Sashikanth Srivastav
Till recently, ST segment elevation in the absence of conduction abnormalities or chest pain occurring particularly in young bradycardia individuals has been considered a normal variant called early repolarisation (ER). However, recent studies suggest a more worrisome picture as patients with history of idiopathic ventricular fibrillation showed increased prevalence of ER in ECG. ER is an ECG pattern characterised by elevation of the QRS-ST junction (J point) ≥ 2 mv from baseline in the inferior (II, III, aVF) or lateral (I, aVL, V4-V6) leads manifested as QRS slurring or notching...
July 2016: Journal of the Association of Physicians of India
Deniz Akdis, Corinna Brunckhorst, Firat Duru, Ardan M Saguner
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes...
August 2016: Arrhythmia & Electrophysiology Review
Giulio Conte, Maria Luce Caputo, François Regoli, Tiziano Moccetti, Pedro Brugada, Angelo Auricchio
Brugada and early repolarisation (ER) syndromes are currently considered two distinct inherited electrical disorders with overlapping clinical and electrocardiographic features. A considerable number of patients diagnosed with ER syndrome have a genetic mutation related to Brugada syndrome (BrS). Due to the high variable phenotypic manifestation, patients with BrS may present with inferolateral repolarisation abnormalities only, resembling the ER pattern. Moreover, the complex genotype-phenotype interaction in BrS can lead to the occurrence of mixed phenotypes with ER syndrome...
August 2016: Arrhythmia & Electrophysiology Review
Woo Seok Lee, Gi-Byoung Nam, Sung-Hwan Kim, Jin Hee Choi, Uk Jo, Won Young Kim, Yong-Seog Oh, Kyu Nam Park, Guang-Won Seo, Ki-Hun Kim, Eun-Sun Jin, Kyoung-Suk Rhee, Laeyoung Jung, Ki-Won Hwang, Yoo Ri Kim, Chang Hee Kwon, Jun Kim, Kee-Joon Choi, You-Ho Kim
OBJECTIVE: Hypothermia can induce ECG J waves. Recent studies suggest that J waves may be associated with ventricular fibrillation (VF) in patients with structurally normal hearts. However, little is known about the ECG features, clinical significance or arrhythmogenic potentials of therapeutic hypothermia (TH)-induced J waves. METHODS: We analysed ECGs from 240 patients who underwent TH at six major university hospitals in Korea between August 2010 and December 2013...
October 1, 2016: Heart: Official Journal of the British Cardiac Society
Demosthenes G Katritsis, Bernard J Gersh, A John Camm
New concepts regarding early repolarisation syndrome are presented. Genetics and epidemiology data, as well as new evidence on the potential clinical significance of early repolarisation patterns, are discussed.
December 2015: Arrhythm Electrophysiol Rev
Manoj N Obeyesekere, Andrew D Krahn
The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk...
August 2015: Arrhythm Electrophysiol Rev
Abdulrahman Naseef, Elijah R Behr, Velislav N Batchvarov
The Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. The diagnosis of the BrS is mainly based on the presence of a spontaneous or Na + channel blocker induced characteristic, electrocardiographic (ECG) pattern (type 1 or coved Brugada ECG pattern) typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal (i.c.) spaces. This pattern needs to be distinguished from similar ECG changes due to other causes (Brugada ECG phenocopies)...
April 2015: Journal of the Saudi Heart Association
Kamal K Sethi, Kabir Sethi, Surendra K Chutani
J wave syndrome has emerged as a significant cause of Idiopathic ventricular fibrillation (IVF) responsible for sudden cardiac death. A large body of data is now available on genesis, genetics and ionic mechanisms of J wave syndromes. Two of these viz., Early repolarization syndrome (ER) and Brugada syndrome (BrS) are fairly well characterized enabling correct diagnosis in most patients. The first part of repolarization of ventricular myocardium is governed by Ito current i.e., rapid outward potassium current...
July 2014: Indian Heart Journal
Frederic Sacher, Nicolas Derval, Marc Horlitz, Michel Haïssaguerre
We present the case of a 14-year-old female with early repolarization syndrome who presented with recurrent ventricular fibrillation and ICD shocks which were refractory to multiple drugs and catheter ablation. Treatment with quinidine, an Ito blocker, resulted in a normalization of J waves and suppression of VF. Interestingly, J wave amplitude correlated with the ventricular arrhythmia susceptibility and quinidine levels. The case highlights the importance of quinidine for management of ventricular arrhythmias in the context of early repolarisation and suggests that J wave amplitude may be an important indicator of therapeutic drug levels and arrhythmia susceptibility...
March 2014: Journal of Electrocardiology
Hyung Oh Choi, Gi-Byoung Nam, Eun-Sun Jin, Ki-Hun Kim, Sung-Hwan Kim, Eui-Seock Hwang, Kyoung-Min Park, Jun Kim, Kyoung-Suk Rhee, Kee-Joon Choi, You-Ho Kim
OBJECTIVE: Electrocardiographic markers identifying malignant forms of early repolarisation (ER) from ER of normal variants are of prime clinical importance. We compared the ECG parameters of ER patterns in patients with early repolarisation syndrome (ERS) proximate to the ventricular fibrillation (VF) episodes, remote from the events and those with normal controls with ER. DESIGN: A retrospective, case-control study. SETTING: University hospital...
December 2013: Heart: Official Journal of the British Cardiac Society
Peter W Macfarlane, Elaine N Clark, Jacob S Heng
The recent resurgence of interest in early repolarization has demonstrated a variation in the definition of the term and a consequent variation in the prevalence of the pattern in different studies. This can vary from 35% in males and 21.5% in females if ST elevation is not considered part of the definition, to 3.3% and 0.5% in females with the inclusion of ST elevation. In contrast, the prevalence of the Brugada Syndrome is in the order of 0.1%-0.2% in Japan for example and has been found to be significantly lower in Denmark...
November 2013: Journal of Electrocardiology
Antonio Frontera, Glyn Thomas, Edward Duncan
No abstract text is available yet for this article.
April 2014: Heart: Official Journal of the British Cardiac Society
Lars Eckardt, Kristina Wasmer, Julia Köbe, Peter Milberg, Gerold Mönnig
Early repolarization, involving infero-lateral ST segment elevation and prominent J waves at the QRS-ST junction has been considered a normal ECG variant for more than 80 years. More recent studies suggest that this phenomenon is not as benign as earlier believed and may represent a risk for subsequent ventricular fibrillation in patients with and without structural heart disease. However, based on current data it seems unjustified to consider these often accidental ECG findings a marker for high risk of sudden cardiac death...
June 2013: Herzschrittmachertherapie & Elektrophysiologie
Arivalagan Kannivelu, Vikram Kudumula, Vinay Bhole
BACKGROUND: Hyperventilation is known to cause ST segment changes and QT variability in adults, but this has not been systematically studied in children. AIM: To investigate the effect of hyperventilation on rate corrected QT interval (QTc) in children. METHODS AND RESULTS: 25 children (male=10) with a median age of 14 (range 8.3-17.6) years were asked to hyperventilate for 1 min before exercise testing using the modified Bruce protocol. Mean QTc at rest, after hyperventilation, at peak exercise and at 1 min of recovery was 425(±31), 460(±30), 446(±38) and 420(±32) ms, respectively...
February 2013: Archives of Disease in Childhood
Piotr Kukla, Marek Jastrzębski, Marek Kuch
Early repolarisation syndrome (ERS) appears in 2-7% of general population, mainly seen in young men, athletes and blacks. Recent publications change the benign character of ERS. It was suggested that ERS can be associated with sudden cardiac death, idiopathic ventricular fibrillation. This article described history and evolution of ERS.
2012: Kardiologia Polska
Rachel Bastiaenen, Elijah R Behr
Early repolarisation was previously considered a benign variant but in recent years has emerged as a marker of risk for sudden death. In part, this appears to reflect a change in the definition. ECG territory, degree of J-point elevation and ST-segment morphology are associated with different degrees of risk for subsequent ventricular arrhythmia. At present the dataset is insufficient to allow risk stratification in asymptomatic individuals and further epidemiological and mechanistic research is required.
June 2012: Heart: Official Journal of the British Cardiac Society
Jaroslav Simon, Petr Neuzil
Syndrome of early repolarisation is a relatively not common electrocardiographic pattern with typically elevated J wave in most of the cases in lead II, III, aVF and V3-V6. There is increasing evidence that the early repolarisation might be associated with increased risk of sudden cardiac death in otherwise healthy individuals. Early repolarisation ECG pattern in inferolateral leads is associated with sudden death in younger otherwise healthy individuals. Identification of this risky group based on pure ECG criteria is still challenging but it must be considered in individuals with family history of sudden cardiac death or cardiac arrest...
2011: Casopís Lékar̆ů C̆eských
Bernd Kallmünzer, Joji Kuramatsu, Lorenz Breuer, Tobias Engelhorn, Martin Köhrmann
No abstract text is available yet for this article.
2011: Cerebrovascular Diseases
Nicolas Franchitto, Claudine Cabot, Nicolas Dumonteil, Vincent Bounes, Atul Pathak, Daniel Rougé
Chest pain is a common reason why cocaine-addicted patients call the emergency department, and acute coronary syndromes are difficult to diagnose in these situations. A 30-year-old cocaine-user patient contacts the Emergency Medical Assistance Service with constrictive chest pain. A doctor is sent out to the patient at home. The initial ECG is normal. No other aetiology of chest pain is revealed, except nicotine and cocaine addictions. First, a coronary artery spasm is suggested, caused by the injection of cocaine...
March 2012: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
J Bhar-Amato, Lm Nunn, Pd Lambiase
Brugada syndrome (BrS) is characterised by the triad of coved ST elevation, lethal ventricular arrhythmia in an apparently structurally normal heart. The precise mechanisms responsible for the coved ST elevation and ventricular arrhythmias in this disease have been debated since its initial description in 1992. Indeed the recent recognition of early repolarisation J wave disorders linked to primary VF broadens the mechanistic importance of BrS in sudden cardiac death. It may lie on a spectrum of early repolarisation pathology which is becoming increasingly recognised as a marker of premature cardiovascular death...
2010: Indian Pacing and Electrophysiology Journal
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