BACKGROUND: Inferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF). OBJECTIVE: The purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER. METHODS: We 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). RESULTS: Compared 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. CONCLUSION: Patients 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.

Centre Hospitalier Universitaire de Strasbourg Strasbourg France

Centre Hospitalier Universitaire de Toulouse Toulouse France

CHU de Bordeaux IHU Institut de Rythmologie et Modélisation Cardiaque Université Bordeaux Inserm U1045 Bordeaux France

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 Bern Bern Switzerland

CTU Bern Department of Clinical Research and Institute of Social and Preventive Medicine University of Bern Bern Switzerland

Département de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires AP HP Hôpital Bichat Université Paris Diderot Sorbonne Paris Cité Paris France

Department of Cardiology Toulouse University School of Medicine Toulouse France

Deutsches Herzzentrum München München Germany

Institute for Clinical and Experimental Medicine Prague Czech Republic

L׳institut du thorax service de cardiologie du CHU de Nantes Nantes France

Heart Rhythm. 2016 Apr;13(4):903-4. doi: 10.1016/j.hrthm.2015.12.017. PubMed

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