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Early Repolarization Pattern (Erp) Essay

1621 words - 7 pages


Early repolarization pattern (ERP) is an enigmatic common electrocardiographic (ECG) finding,occurring in 1% to 2% of the general population (1). ERP prevalence is decreasing with advancing age (2) This ECG pattern is frequently observed in healthy persons,particularly young,male (3,4,5), athletic (6,7), and of African-American origin (4,5,6,7,8).On the 12-lead ECG the ERP is characterized as “notching” or “slurring” of the terminal portion of the R wave and beginning of the ST-segment that produces a positive hump known as J wave. The J wave is a deflection with a dome that appears immediately after the end of QRS complex followed by ST-segment elevation ≥ 0.1 mV (or 1 mm, varying from 1 to 4 mm) above isoelectric line (relative to the subsequent TP interval) concave upward in at least two contiguous ECG leads. This ECG finding is most frequently seen in the precordial leads from V3 to V5 and often in the inferior leads II, III, and aVF (9)
Normal ERP should be differentiated from others conditions with ST segment elevation such as asthenic habitus, acute pericarditis, STEMI,Brugada syndrome (BrS), congenital short QT syndrome(SQTS), and IVF (10,11).
Although the condition is usually considered benign, its potential arrhythmogenicity has been suggested by experimental studies.(12)
The majority of such sudden cardiac arrests are caused by ventricular tachyarrhythmias,
which occur in persons without structural heart disease in 6 to 14% of cases. (13,14)
These results were replicated in similar studies and the association with increased arrhythmic risk was subsequently extended to the general population in large cohort studies (16,17).
In brief, ER consists of 2 components: prominent J waves and ST-segment elevation.Whereas a prominent J-wave is the noticeable finding in idiopathic VF.(18,19,20)
ERP with global ST segment elevation in the inferior, lateral, and right precordial leads is associated with increased risk for life-threatening arrhythmias.This lethal entity is named the early repolarization syndrome (ERS).
Although BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves, according to Antzelevitch and Yan [24], both represent a continuous spectrum of phenotypic expression termed J-wave syndromes. These authors proposed three subtypes:
Type 1: ERS observed predominantly in the lateral precordial leads, prevalent among healthy male athletes and rarely seen in IVF survivors; Type 2: ERS predominantly in the inferior or inferolateral leads and associated with a higher level of risk; Type 3: ERS globally in the inferior, lateral, and right precordial leads and associated with the highest level of risk for development of malignant arrhythmias.Type 3 is often associated with IVF storms.
Short-QT syndrome is described as a disorder characterized by abbreviated QT interval, ventricular and atrial arrhythmias,and sudden cardiac death (22)
Recent studies supported an association between short QT...

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