• 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, and You-Ho Kim.
• Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, , Bucheon, Korea.
• Heart. 2013 Dec 1; 99 (24): 1818-24.

ObjectiveElectrocardiographic 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.DesignA retrospective, case-control study.SettingUniversity hospital.PatientsThis study included 12 patients with ERS and 36 age-matched, gender-matched controls with ER.Main Outcome MeasuresDynamic change of J-wave.ResultsThe highest amplitude of J-wave, sum of the J-wave amplitudes or the number of leads with ER showed a dramatic change during the perievent period. J-wave amplitudes (2.0±1.3 vs 4.0±1.7, p=0.004) and the number of leads with ER (3.3±1.7 vs 5.3±2.0, p=0.021) were significantly higher around the time of VF. In particular, the characteristic morphology of 'giant' (wide, >80 ms) J-waves were observed during the perievent period in 5/12 patients with ERS. However, there were no significant differences in the electrocardiographic parameters of ER pattern remote from VF events between the patients with ERS and normal control subjects with ER.ConclusionsAlthough the extent of and amplitude of J-wave or ST segment elevation (STE) increased significantly around VF episodes, the electrocardiographic parameters of ER remote from VF episodes were not significantly different from those of normal controls. The narrow time window of these ECG changes limits early detection of ER patients at risk of developing VF or sudden cardiac death.

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