• Laurent Roten, Nicolas Derval, Philippe Maury, Saagar Mahida, Patrizio Pascale, Antoine Leenhardt, Laurence Jesel, Isabel Deisenhofer, Josef Kautzner, Vincent Probst, Anne Rollin, Jean-Bernard Ruidavets, J... more ean Ferrières, Frédéric Sacher, Dik Heg, Daniel Scherr, Yuki Komatsu, Matthew Daly, Arnaud Denis, Ashok Shah, Mélèze Hocini, Pierre Jaïs, and Michel Haïssaguerre. less
• CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France; Department of Cardiology, Inselspital, Bern University Hospital, and University of... more Bern, Bern, Switzerland. Electronic address: laurent.roten@insel.ch. less
• Heart Rhythm. 2016 Apr 1; 13 (4): 894-902.

BackgroundInferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF).ObjectiveThe purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER.MethodsWe compared the ECGs of patients with ER and VF (n = 92) with control subjects with asymptomatic ER (n = 247). We assessed J-wave amplitude, QTc interval, T-wave/R-wave (T/R) ratio in leads II and V5, and presence of low-amplitude T waves (T-wave amplitude <0.1 mV and <10% of R-wave amplitude in lead I, II, or V4-V6).ResultsCompared to controls, the VF group had longer QTc intervals (388 ms vs. 377 ms, P = .001), higher J-wave amplitudes (0.23 mV vs. 0.17 mV, P <.001), higher prevalence of low-amplitude T waves (29% vs. 3%, P <.001), and lower T/R ratio (0.18 vs. 0.30, P <.001). Logistic regression analysis demonstrated that QTc interval (odds ratio [OR] per 10 ms: 1.15, 95% confidence interval [CI} 1.02-1.30), maximal J-wave amplitude (OR per 0.1 mV: 1.68, 95% CI 1.23-2.31), lower T/R ratio (OR per 0.1 unit: 0.62, 95% CI 0.47-0.81), presence of low-amplitude T waves (OR 3.53, 95% CI 1.26-9.88). and presence of J waves in the inferior leads (OR 2.58, 95% CI 1.18-5.65) were associated with malignant ER.ConclusionPatients with malignant ER have a higher prevalence of low-amplitude T waves, lower T/R ratio (lead II or V5), and longer QTc interval. The combination of these parameters with J-wave amplitude and distribution of J waves may allow for improved identification of malignant ER.Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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