• Nicolas Derval, Christopher S Simpson, David H Birnie, Jeffrey S Healey, Vijay Chauhan, Jean Champagne, Martin Gardner, Shubhayan Sanatani, Raymond Yee, Allan C Skanes, Lorne J Gula, Peter Leong-Sit, Kamran Ahmad, Michael H Gollob, Michel Haïssaguerre, George J Klein, and Andrew D Krahn.
• Hopital Haut Lévêque, CHU Bordeaux, University Bordeaux 2, Bordeaux, France.
• J. Am. Coll. Cardiol. 2011 Aug 9;58(7):722-8.

ObjectivesWe evaluated the prevalence and characteristics of early repolarization in patients in CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry).BackgroundEarly repolarization has been implicated in a syndrome of polymorphic ventricular tachycardia and fibrillation in patients without organic heart disease.MethodsOne hundred patients with apparently unexplained cardiac arrest and preserved ejection fraction underwent extensive clinical and genetic testing to unmask subclinical electrical or structural disease. A blinded independent analysis of the 12-lead electrocardiogram (ECG) was performed. Early repolarization was defined as ≥0.1 mV QRS-ST junction (J-point) elevation with terminal QRS slurring or notching in at least 2 contiguous inferior and/or lateral leads.ResultsOne hundred cardiac arrest patients were enrolled (40 females, age 43 ± 14 years). Forty-four were diagnosed with an established cause for cardiac arrest. Significant early repolarization was found in 19 patients, including 6 with a primary diagnosis that explained their cardiac arrest (14%), compared with 23% of the 56 patients with idiopathic ventricular fibrillation (IVF) (p = 0.23). J-point elevation in IVF patients had higher amplitude (0.25 ± 0.11 mV vs. 0.13 ± 0.05 mV, p = 0.02) and wider distribution (4.3 ± 1.3 leads vs. 2.8 ± 0.8 leads; p = 0.01) than those with an established cause of cardiac arrest. J-wave amplitude was fluctuant on serial ECGs; at least 1 ECG failed to demonstrate early repolarization in 58% of patients.ConclusionsEarly repolarization is present in a significant proportion of causally diagnosed and idiopathic VF. It is often intermittent and more pronounced in IVF patients. (Registry of Unexplained Cardiac Arrest; NCT00292032).Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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