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Benign early repolarization

May 05, 2024

Benign early repolarization (BER) or early repolarization is found on an electrocardiogram (ECG) in about 1% of those with chest pain.[2] It is diagnosed based on an elevated J-point / ST elevation with an end-QRS notch or end-QRS slur and where the ST segment concave up. It is believed to be a normal variant.[2]

Benign early repolarization
Classic and new definitions of early repolarization with end-QRS notching and end-QRS slurring
ECG of a benign early repolarization in a 15-year-old male
SpecialtyCardiology
Frequency1-13%[1]

Benign early repolarization that occurs as some patterns is associated with ventricular fibrillation. The association, revealed by research performed in the late 2000s, is very small.

Types edit

Benign early repolarization, very prevalent in younger people and healthy male athletes, can be divided into 3 subtypes:[3][4]

  • Type 1 – BER pattern seen in lateral precordial leads.
  • Type 2 – BER pattern seen in inferior or inferolateral leads.
  • Type 3 – BER pattern seen globally (inferior, lateral, right precordial leads).

Associations with serious conditions edit

Research in the late 2000s has linked this finding when found as some patterns to ventricular fibrillation, particularly in those who have fainted or have a family history of sudden cardiac death.[5][6][7] Although there is a significant relationship between ventricular fibrillation and some early repolarization's patterns, the overall lifetime occurrence of idiopathic ventricular fibrillation is exceptionally rare.[8] There has also been an association between early repolarization and short QT syndrome.[9]

Risk factors edit

  • Male gender[10]
  • J-point and horizontal or descending / downsloping ST segment (especially in inferior leads)[10][11][12]
  • Elevation of ST segment by 2 mm[10]
  • Elevation of a J-wave by 0.2 mV or more[13]
  • J-point distribution globally[13]
  • QRS longer than 110 ms[13]
  • Longer duration of J wave, more than 60 ms[14]

Electrocardiography edit

On an electrocardiogram (EKG or ECG), benign early repolarization may produce an elevation of the J-point and ST segment in 2 or more leads, similar to that observed in heart attacks (myocardial infarction). However, with benign early repolarization, the ST segment is usually concave up, rather than concave down (as with heart attacks), and there is a notable absence of reciprocal changes suggestive of ischemia on the EKG.

Causes edit

It is thought that the mechanism causing early repolarization is a more excitable ion channel system, which causes a faster myocardium contraction.[13] Studies have shown that higher testosterone levels in males result in an increased outward potassium currents causing J-point elevation.[15]

Epidemiology edit

Benign early repolarization occurs in about 1 to 13 percent of the general population with a significant increase in occurrence within athletes and adolescents.[1] In one study, an occurrence of early repolarization was observed in 31.6% of elite athletes while in another study occurrence was observed in 25.1% of athletes.[16][17]

Being a male is strongly associated with early repolarization ECG pattern, and 70% of subjects with early repolarization are males. Prevalence of early repolarization declines in males from early adulthood until middle-age which could suggest a hormonal influence on its presence. Early repolarization patterns are more common in physically active younger individuals, athletes and Africans.[18]

Genetics edit

Genes associated with ER and ATP sensitive potassium current channel mutations are KCNJ8, ABCC9[11][19][20] Others associated with transient outward potassium current - KCNE5, DPP10, L-type voltage gated calcium current - CACNA1C, CACNB2B, CACNA2D1, sodium current - SCN5A, SCN10A.[14]

History edit

Early repolarization with ST segment elevation was first described in 1936 by R.A. Shipley and W.R. Hallaran in a study of 200 healthy 20–35 year old people.[14][21]

References edit

  1. ^ a b Bourier F, Denis A, Cheniti G, Lam A, Vlachos K, Takigawa M, et al. (2018-11-27). "Early Repolarization Syndrome: Diagnostic and Therapeutic Approach". Frontiers in Cardiovascular Medicine. 5: 169. doi:10.3389/fcvm.2018.00169. PMC 6278243. PMID 30542653.
  2. ^ a b Brady WJ, Chan TC (1999). "Electrocardiographic manifestations: benign early repolarization". The Journal of Emergency Medicine. 17 (3): 473–478. doi:10.1016/S0736-4679(99)00010-4. PMID 10338242.
  3. ^ Buttner R, Cadogan M (2021-01-21). "'Benign' Early Repolarization Misnomer". Life in the Fast Lane • LITFL. Retrieved 2021-12-25.
  4. ^ Antzelevitch C, Yan GX, Viskin S (April 2011). "Rationale for the use of the terms J-wave syndromes and early repolarization". Journal of the American College of Cardiology. 57 (15): 1587–1590. doi:10.1016/j.jacc.2010.11.038. PMC 3073061. PMID 21474038.
  5. ^ Stern S (April 2011). "Clinical aspects of the early repolarization syndrome: a 2011 update". Annals of Noninvasive Electrocardiology. 16 (2): 192–195. doi:10.1111/j.1542-474X.2011.00429.x. PMC 6932469. PMID 21496171.
  6. ^ Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. (May 2008). "Sudden cardiac arrest associated with early repolarization". The New England Journal of Medicine. 358 (19): 2016–2023. doi:10.1056/NEJMoa071968. PMID 18463377.
  7. ^ Nam GB, Kim YH, Antzelevitch C (May 2008). "Augmentation of J waves and electrical storms in patients with early repolarization". The New England Journal of Medicine. 358 (19): 2078–2079. doi:10.1056/NEJMc0708182. PMC 2515862. PMID 18463391.
  8. ^ Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. (October 2013). "Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes". Europace. 15 (10): 1389–1406. doi:10.1093/europace/eut272. PMID 23994779.
  9. ^ Watanabe H, Makiyama T, Koyama T, Kannankeril PJ, Seto S, Okamura K, et al. (May 2010). "High prevalence of early repolarization in short QT syndrome". Heart Rhythm. 7 (5): 647–652. doi:10.1016/j.hrthm.2010.01.012. PMID 20206319.
  10. ^ a b c Junttila MJ, Sager SJ, Tikkanen JT, Anttonen O, Huikuri HV, Myerburg RJ (November 2012). "Clinical significance of variants of J-points and J-waves: early repolarization patterns and risk". European Heart Journal. 33 (21): 2639–2643. doi:10.1093/eurheartj/ehs110. PMID 22645193.
  11. ^ a b Mercer BN, Begg GA, Page SP, Bennett CP, Tayebjee MH, Mahida S (2016-06-30). "Early Repolarization Syndrome; Mechanistic Theories and Clinical Correlates". Frontiers in Physiology. 7: 266. doi:10.3389/fphys.2016.00266. PMC 4927622. PMID 27445855.
  12. ^ Sethi, Kamal K.; Sethi, Kabir; Chutani, Surendra K. (2014). "Early repolarisation and J wave syndromes". Indian Heart Journal. 66 (4): 443–452. doi:10.1016/j.ihj.2014.06.002. ISSN 0019-4832. PMC 4150048. PMID 25173204.
  13. ^ a b c d Sayedahmad Z, Darmoch F, Al-Khadra Y, Kabach A, Alraies MC (March 2019). "Does early repolarization on ECG increase the risk of cardiac death in healthy people?". Cleveland Clinic Journal of Medicine. 86 (3): 165–166. doi:10.3949/ccjm.86a.17032. PMID 30849033. S2CID 73467268.
  14. ^ a b c "Early Repolarization Syndrome". American College of Cardiology. Retrieved 2021-12-25.
  15. ^ Bourier, Felix; Denis, Arnaud; Cheniti, Ghassen; Lam, Anna; Vlachos, Konstantinos; Takigawa, Masateru; Kitamura, Takeshi; Frontera, Antonio; Duchateau, Josselin; Pambrun, Thomas; Klotz, Nicolas (2018). "Early Repolarization Syndrome: Diagnostic and Therapeutic Approach". Frontiers in Cardiovascular Medicine. 5: 169. doi:10.3389/fcvm.2018.00169. ISSN 2297-055X. PMC 6278243. PMID 30542653.
  16. ^ Serra-Grima R, Doñate M, Álvarez-García J, Barradas-Pires A, Ferrero A, Carballeira L, et al. (February 2015). "Long-term follow-up of early repolarization pattern in elite athletes". The American Journal of Medicine. 128 (2): 192.e1–192.e9. doi:10.1016/j.amjmed.2014.06.017. PMID 24979742.
  17. ^ Noseworthy PA, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, et al. (August 2011). "Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training". Circulation: Arrhythmia and Electrophysiology. 4 (4): 432–440. doi:10.1161/CIRCEP.111.962852. PMC 3700366. PMID 21543642.
  18. ^ Sethi KK, Sethi K, Chutani SK (2014). "Early repolarisation and J wave syndromes". Indian Heart Journal. 66 (4): 443–452. doi:10.1016/j.ihj.2014.06.002. PMC 4150048. PMID 25173204.
  19. ^ Haïssaguerre M, Chatel S, Sacher F, Weerasooriya R, Probst V, Loussouarn G, et al. (January 2009). "Ventricular fibrillation with prominent early repolarization associated with a rare variant of KCNJ8/KATP channel". Journal of Cardiovascular Electrophysiology. 20 (1): 93–98. doi:10.1111/j.1540-8167.2008.01326.x. PMID 19120683. S2CID 21002962.
  20. ^ Medeiros-Domingo A, Tan BH, Crotti L, Tester DJ, Eckhardt L, Cuoretti A, et al. (October 2010). "Gain-of-function mutation S422L in the KCNJ8-encoded cardiac K(ATP) channel Kir6.1 as a pathogenic substrate for J-wave syndromes". Heart Rhythm. 7 (10): 1466–1471. doi:10.1016/j.hrthm.2010.06.016. PMC 3049900. PMID 20558321.
  21. ^ Shipley RA, Hallaran W (1936-03-01). "The four-lead electrocardiogram in two hundred normal men and women". American Heart Journal. 11 (3): 325–345. doi:10.1016/S0002-8703(36)90417-9.

Further reading edit

  • Macfarlane PW, Antzelevitch C, Haissaguerre M, Huikuri HV, Potse M, Rosso R, et al. (July 2015). "The Early Repolarization Pattern: A Consensus Paper". Journal of the American College of Cardiology. 66 (4): 470–477. doi:10.1016/j.jacc.2015.05.033. PMID 26205599. S2CID 205571235.
  • Junttila MJ, Sager SJ, Tikkanen JT, Anttonen O, Huikuri HV, Myerburg RJ (November 2012). "Clinical significance of variants of J-points and J-waves: early repolarization patterns and risk". European Heart Journal. 33 (21): 2639–2643. doi:10.1093/eurheartj/ehs110. PMID 22645193.

External links edit

  • Benign Early Repolarisation on litfl.com
  • Early Repolarization – ECGpedia

May 05, 2024
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Benign early repolarization BER or early repolarization is found on an electrocardiogram ECG in about 1 of those with chest pain 2 It is diagnosed based on an elevated J point ST elevation with an end QRS notch or end QRS slur and where the ST segment concave up It is believed to be a normal variant 2 Benign early repolarizationClassic and new definitions of early repolarization with end QRS notching and end QRS slurringECG of a benign early repolarization in a 15 year old maleSpecialtyCardiologyFrequency1 13 1 Benign early repolarization that occurs as some patterns is associated with ventricular fibrillation The association revealed by research performed in the late 2000s is very small Contents 1 Types 2 Associations with serious conditions 2 1 Risk factors 3 Electrocardiography 4 Causes 5 Epidemiology 6 Genetics 7 History 8 References 9 Further reading 10 External linksTypes editBenign early repolarization very prevalent in younger people and healthy male athletes can be divided into 3 subtypes 3 4 Type 1 BER pattern seen in lateral precordial leads Type 2 BER pattern seen in inferior or inferolateral leads Type 3 BER pattern seen globally inferior lateral right precordial leads Associations with serious conditions editResearch in the late 2000s has linked this finding when found as some patterns to ventricular fibrillation particularly in those who have fainted or have a family history of sudden cardiac death 5 6 7 Although there is a significant relationship between ventricular fibrillation and some early repolarization s patterns the overall lifetime occurrence of idiopathic ventricular fibrillation is exceptionally rare 8 There has also been an association between early repolarization and short QT syndrome 9 Risk factors edit Male gender 10 J point and horizontal or descending downsloping ST segment especially in inferior leads 10 11 12 Elevation of ST segment by 2 mm 10 Elevation of a J wave by 0 2 mV or more 13 J point distribution globally 13 QRS longer than 110 ms 13 Longer duration of J wave more than 60 ms 14 Electrocardiography editOn an electrocardiogram EKG or ECG benign early repolarization may produce an elevation of the J point and ST segment in 2 or more leads similar to that observed in heart attacks myocardial infarction However with benign early repolarization the ST segment is usually concave up rather than concave down as with heart attacks and there is a notable absence of reciprocal changes suggestive of ischemia on the EKG Causes editIt is thought that the mechanism causing early repolarization is a more excitable ion channel system which causes a faster myocardium contraction 13 Studies have shown that higher testosterone levels in males result in an increased outward potassium currents causing J point elevation 15 Epidemiology editBenign early repolarization occurs in about 1 to 13 percent of the general population with a significant increase in occurrence within athletes and adolescents 1 In one study an occurrence of early repolarization was observed in 31 6 of elite athletes while in another study occurrence was observed in 25 1 of athletes 16 17 Being a male is strongly associated with early repolarization ECG pattern and 70 of subjects with early repolarization are males Prevalence of early repolarization declines in males from early adulthood until middle age which could suggest a hormonal influence on its presence Early repolarization patterns are more common in physically active younger individuals athletes and Africans 18 Genetics editGenes associated with ER and ATP sensitive potassium current channel mutations are KCNJ8 ABCC9 11 19 20 Others associated with transient outward potassium current KCNE5 DPP10 L type voltage gated calcium current CACNA1C CACNB2B CACNA2D1 sodium current SCN5A SCN10A 14 History editEarly repolarization with ST segment elevation was first described in 1936 by R A Shipley and W R Hallaran in a study of 200 healthy 20 35 year old people 14 21 References edit a b Bourier F Denis A Cheniti G Lam A Vlachos K Takigawa M et al 2018 11 27 Early Repolarization Syndrome Diagnostic and Therapeutic Approach Frontiers in Cardiovascular Medicine 5 169 doi 10 3389 fcvm 2018 00169 PMC 6278243 PMID 30542653 a b Brady WJ Chan TC 1999 Electrocardiographic manifestations benign early repolarization The Journal of Emergency Medicine 17 3 473 478 doi 10 1016 S0736 4679 99 00010 4 PMID 10338242 Buttner R Cadogan M 2021 01 21 Benign Early Repolarization Misnomer Life in the Fast Lane LITFL Retrieved 2021 12 25 Antzelevitch C Yan GX Viskin S April 2011 Rationale for the use of the terms J wave syndromes and early repolarization Journal of the American College of Cardiology 57 15 1587 1590 doi 10 1016 j jacc 2010 11 038 PMC 3073061 PMID 21474038 Stern S April 2011 Clinical aspects of the early repolarization syndrome a 2011 update Annals of Noninvasive Electrocardiology 16 2 192 195 doi 10 1111 j 1542 474X 2011 00429 x PMC 6932469 PMID 21496171 Haissaguerre M Derval N Sacher F Jesel L Deisenhofer I de Roy L et al May 2008 Sudden cardiac arrest associated with early repolarization The New England Journal of Medicine 358 19 2016 2023 doi 10 1056 NEJMoa071968 PMID 18463377 Nam GB Kim YH Antzelevitch C May 2008 Augmentation of J waves and electrical storms in patients with early repolarization The New England Journal of Medicine 358 19 2078 2079 doi 10 1056 NEJMc0708182 PMC 2515862 PMID 18463391 Priori SG Wilde AA Horie M Cho Y Behr ER Berul C et al October 2013 Executive summary HRS EHRA APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes Europace 15 10 1389 1406 doi 10 1093 europace eut272 PMID 23994779 Watanabe H Makiyama T Koyama T Kannankeril PJ Seto S Okamura K et al May 2010 High prevalence of early repolarization in short QT syndrome Heart Rhythm 7 5 647 652 doi 10 1016 j hrthm 2010 01 012 PMID 20206319 a b c Junttila MJ Sager SJ Tikkanen JT Anttonen O Huikuri HV Myerburg RJ November 2012 Clinical significance of variants of J points and J waves early repolarization patterns and risk European Heart Journal 33 21 2639 2643 doi 10 1093 eurheartj ehs110 PMID 22645193 a b Mercer BN Begg GA Page SP Bennett CP Tayebjee MH Mahida S 2016 06 30 Early Repolarization Syndrome Mechanistic Theories and Clinical Correlates Frontiers in Physiology 7 266 doi 10 3389 fphys 2016 00266 PMC 4927622 PMID 27445855 Sethi Kamal K Sethi Kabir Chutani Surendra K 2014 Early repolarisation and J wave syndromes Indian Heart Journal 66 4 443 452 doi 10 1016 j ihj 2014 06 002 ISSN 0019 4832 PMC 4150048 PMID 25173204 a b c d Sayedahmad Z Darmoch F Al Khadra Y Kabach A Alraies MC March 2019 Does early repolarization on ECG increase the risk of cardiac death in healthy people Cleveland Clinic Journal of Medicine 86 3 165 166 doi 10 3949 ccjm 86a 17032 PMID 30849033 S2CID 73467268 a b c Early Repolarization Syndrome American College of Cardiology Retrieved 2021 12 25 Bourier Felix Denis Arnaud Cheniti Ghassen Lam Anna Vlachos Konstantinos Takigawa Masateru Kitamura Takeshi Frontera Antonio Duchateau Josselin Pambrun Thomas Klotz Nicolas 2018 Early Repolarization Syndrome Diagnostic and Therapeutic Approach Frontiers in Cardiovascular Medicine 5 169 doi 10 3389 fcvm 2018 00169 ISSN 2297 055X PMC 6278243 PMID 30542653 Serra Grima R Donate M Alvarez Garcia J Barradas Pires A Ferrero A Carballeira L et al February 2015 Long term follow up of early repolarization pattern in elite athletes The American Journal of Medicine 128 2 192 e1 192 e9 doi 10 1016 j amjmed 2014 06 017 PMID 24979742 Noseworthy PA Weiner R Kim J Keelara V Wang F Berkstresser B et al August 2011 Early repolarization pattern in competitive athletes clinical correlates and the effects of exercise training Circulation Arrhythmia and Electrophysiology 4 4 432 440 doi 10 1161 CIRCEP 111 962852 PMC 3700366 PMID 21543642 Sethi KK Sethi K Chutani SK 2014 Early repolarisation and J wave syndromes Indian Heart Journal 66 4 443 452 doi 10 1016 j ihj 2014 06 002 PMC 4150048 PMID 25173204 Haissaguerre M Chatel S Sacher F Weerasooriya R Probst V Loussouarn G et al January 2009 Ventricular fibrillation with prominent early repolarization associated with a rare variant of KCNJ8 KATP channel Journal of Cardiovascular Electrophysiology 20 1 93 98 doi 10 1111 j 1540 8167 2008 01326 x PMID 19120683 S2CID 21002962 Medeiros Domingo A Tan BH Crotti L Tester DJ Eckhardt L Cuoretti A et al October 2010 Gain of function mutation S422L in the KCNJ8 encoded cardiac K ATP channel Kir6 1 as a pathogenic substrate for J wave syndromes Heart Rhythm 7 10 1466 1471 doi 10 1016 j hrthm 2010 06 016 PMC 3049900 PMID 20558321 Shipley RA Hallaran W 1936 03 01 The four lead electrocardiogram in two hundred normal men and women American Heart Journal 11 3 325 345 doi 10 1016 S0002 8703 36 90417 9 Further reading editMacfarlane PW Antzelevitch C Haissaguerre M Huikuri HV Potse M Rosso R et al July 2015 The Early Repolarization Pattern A Consensus Paper Journal of the American College of Cardiology 66 4 470 477 doi 10 1016 j jacc 2015 05 033 PMID 26205599 S2CID 205571235 Junttila MJ Sager SJ Tikkanen JT Anttonen O Huikuri HV Myerburg RJ November 2012 Clinical significance of variants of J points and J waves early repolarization patterns and risk European Heart Journal 33 21 2639 2643 doi 10 1093 eurheartj ehs110 PMID 22645193 External links editBenign Early Repolarisation on litfl com Early Repolarization ECGpedia Retrieved from https en wikipedia org w index php title Benign early repolarization amp oldid 1216159164, wikipedia, wiki, book, books, library,

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