Post by Bjs04f on Jan 28, 2015 15:48:15 GMT -5
Benign early repol, not as benign as once though. Recent studies have suggested that early repolarization (ER) might be associated with up to 1/3 of idiopathic ventricular tachycardia/ventricular fibrillation (VT/VF) cases. In a recent prospective study of STEMI patients, BER was associated with higher rates of in-hospital ventricular arrhythmias and mortality; It is an independent predictor of long-term mortality beyond well-known other parameters. Findings showed that the early repolarization pattern of 0.1 mV was present in 630 subjects (5.8%), 384 (3.5%) of which occurred in the inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). Upon further review, it was found that J-point elevation of at least 0.1 mV in the inferior leads was associated with a similar increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P = 0.03) when compared to these elevations in the lateral leads (adjusted relative risk of 1.34; 95% CI, 1.04 to 1.74; P= 0.03). In addition, 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) when compared to that in the lateral leads, where the data was not statistically significant (adjusted relative risk, 1.61; 95% CI, 0.83 to 3.10; P = 0.19). In addition, J-point elevations of more than 0.2 mV in the inferior leads had a statistically significant risk of death from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P = 0.01) when compared to that in the lateral leads where it was not statistically significant.
Based on the findings above, early repolarization in the inferior leads appeared to be a strong predictor of death from cardiac causes or from arrhythmia than J-point elevation in the lateral leads. In addition to the location of the early-repolarization pattern, the amplitude of the J-point elevation had great prognostic value. There was a significantly higher risk of death from cardiac causes among subjects with a markedly elevated J point (>0.2 mV) than among those with a more moderate elevation (≥0.1 mV). One hypothesis is the concept that the J-point elevation is a marker of increased transmural heterogeneity of ventricular repolarization. In addition, the left ventricular base defined by the inferolateral leads is an area known to have increased current density. As such, having an episode of early repolarization in an area with known increased current density is what can make the myocardium more vulnerable to ventricular tachyarrhythmias
www.ajconline.org/article/S0002-9149(09)01333-2/abstract
umem.org/educational_pearls/2646/
circ.ahajournals.org/content/123/25/2931.full INteresting patient population
Haïssaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008; 358:2016-23.
Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, Reunanen A, Huikuri HV. Long-Term Outcome Associated with Early Repolarization on Electrocardiography. N Engl J Med 2009; 361:2529-2537.
Based on the findings above, early repolarization in the inferior leads appeared to be a strong predictor of death from cardiac causes or from arrhythmia than J-point elevation in the lateral leads. In addition to the location of the early-repolarization pattern, the amplitude of the J-point elevation had great prognostic value. There was a significantly higher risk of death from cardiac causes among subjects with a markedly elevated J point (>0.2 mV) than among those with a more moderate elevation (≥0.1 mV). One hypothesis is the concept that the J-point elevation is a marker of increased transmural heterogeneity of ventricular repolarization. In addition, the left ventricular base defined by the inferolateral leads is an area known to have increased current density. As such, having an episode of early repolarization in an area with known increased current density is what can make the myocardium more vulnerable to ventricular tachyarrhythmias
www.ajconline.org/article/S0002-9149(09)01333-2/abstract
umem.org/educational_pearls/2646/
circ.ahajournals.org/content/123/25/2931.full INteresting patient population
Haïssaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008; 358:2016-23.
Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, Reunanen A, Huikuri HV. Long-Term Outcome Associated with Early Repolarization on Electrocardiography. N Engl J Med 2009; 361:2529-2537.
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