Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study

BMC Cardiovascular Disorders

Kyu-Hyung Ryu⁴  Soon Yong Suh²  Seong Woo Han¹  Sang Man Jung³  Hyun-Joong Kim³  Do Young Kim³  Sung Hea Kim³ 

[1] Department of Cardiology, Korea Guro University Hospital, Seoul, South Korea;Heart Center, Gachon University of Medicine and Science, Gil Hospital, Incheon, South Korea;Department of Internal Medicine, Konkuk University School of Medicine, Konkuk, South Korea;Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, 94-200 Yeongdeungpo-Dong, Yeongdeungpo-Gu, Seoul, 150-719, South Korea

关键词: ST segment;    Early repolarization;    Sudden cardiac death;   

Others  :  857934
DOI  :  10.1186/1471-2261-12-122

 received in 2012-06-02, accepted in 2012-12-04,  发布年份 2012

【 摘 要 】

Background

Risk stratification of the early repolarization pattern (ERP) is needed to identify malignant early repolarization. J-point elevation with a horizontal ST segment was recently suggested as a malignant feature of the ERP. In this study, the prevalence of the ERP with a horizontal ST segment was examined among survivors of sudden cardiac arrest (SCA) without structural heart disease to evaluate the value of ST-segment morphology in risk stratification of the ERP.

Methods

We reviewed the data of 83 survivors of SCA who were admitted from August 2005 to August 2010. Among them, 25 subjects without structural heart disease were included. The control group comprised 60 healthy subjects who visited our health promotion center; all control subjects were matched for age, sex, and underlying disease (diabetes mellitus, hypertension). Early repolarization was defined as an elevation of the J point of at least 0.1 mV above the baseline in at least two continuous inferior or lateral leads that manifested as QRS slurring or notching. An ST-segment pattern of <0.1 mV within 100 ms after the J point was defined as a horizontal ST segment.

Results

The SCA group included 17 men (64%) with a mean age of 49.7 ± 14.5 years. The corrected QTc was not significantly different between the SCA and control groups (432.7 ± 37.96 vs. 420.4 ± 26.3, respectively; p = 0.089). The prevalence of ERP was not statistically different between the SCA and control groups (5/25, 20% vs. 4/60, 6.7%, respectively; p = 0.116). The prevalence of early repolarization with a horizontal ST segment was more frequent in the SCA than in the control group (20% vs. 3.3%, respectively; p = 0.021). Four SCA subjects (16%) and one control subject (1.7%) had a J-point elevation of >2 mm (p = 0.025). Four SCA subjects (16%) and one (1.7%) control subject had an ERP in the inferior lead (p = 0.025).

Conclusion

The prevalence of ERP with a horizontal ST segment was higher in patients with aborted SCA than in matched controls. This result suggests that ST morphology has value in the recognition of malignant early repolarization.

【 授权许可】

   
2012 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al.: Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008, 358:2016-2023.
• [2]Nam GB, Ko KH, Kim J, Park KM, Rhee KS, Choi KJ, et al.: Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. brugada syndrome. Eur Heart J 2010, 31:330-339.
• [3]Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D, et al.: J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 2008, 52:1231-1238.
• [4]Haruta D, Matsuo K, Tsuneto A, Ichimaru S, Hida A, Sera N, et al.: Incidence and prognostic value of early repolarization pattern in the 12-lead electrocardiogram. Circulation 2011, 123:2931-2937.
• [5]Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, et al.: Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 2009, 361:2529-2537.
• [6]Sinner MF, Reinhard W, Muller M, Beckmann BM, Martens E, Perz S, et al.: Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 2010, 7:e1000314.
• [7]Levy S, Sbragia P: ECG repolarization syndrome abnormalities (J wave syndromes) and idiopathic ventricular fibrillation: diagnostic and management. J Interv Card Electrophysiol 2011, 32:181-186.
• [8]Rosso R, Adler A, Halkin A, Viskin S: Risk of sudden death among young individuals with J waves and early repolarization: putting the evidence into perspective. Hear Rhythm 2011, 8:923-929.
• [9]Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T, et al.: Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 2011, 123:2666-2673.
• [10]Uberoi A, Jain NA, Perez M, Weinkopff A, Ashley E, Hadley D, et al.: Early repolarization in an ambulatory clinical population. Circulation 2011, 124:2208-2214.
• [11]Rosso R, Glikson E, Belhassen B, Katz A, Halkin A, Steinvil A, et al.: Distinguishing “benign” from “malignant early repolarization”: the value of the ST-segment morphology. Hear Rhythm 2012, 9:225-229.
• [12]Wasserburger RH, Alt WJ: The normal RS-T segment elevation variant. Am J Cardiol 1961, 8:184-192.
• [13]Kambara H, Phillips J: Long-term evaluation of early repolarization syndrome (normal variant RS-T segment elevation). Am J Cardiol 1976, 38:157-6.
• [14]Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA: The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003, 115:171-177.
• [15]Gussak I, Antzelevitch C: Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 2000, 33:299-309.
• [16]Bastiaenen R, Behr ER: Early repolarisation: controversies and clinical implications. Heart 2012. Epub ahead of print
• [17]Wellens HJ: Early repolarization revisited. N Engl J Med 2008, 358:2063-2065.
• [18]Ohkubo K, Watanabe I, Okumura Y, Kofune M, Nagashima K, Mano H, et al.: Prevalence of prominent J waves in patients presenting with ventricular fibrillation without structural heart disease: a single-center study. J Cardiol 2012, 59:313-320.
• [19]Abe A, Ikeda T, Tsukada T, Ishiguro H, Miwa Y, Miyakoshi M, et al.: Circadian variation of late potentials in idiopathic ventricular fibrillation associated with J waves: insights into alternative pathophysiology and risk stratification. Hear Rhythm 2010, 7:675-682.