Early repolarization

Electrocardiographic phenotypes associated with favorable long-term outcome

Jani T. Tikkanen, M. Juhani Junttila, Olli Anttonen, Aapo L. Aro, Samuli Luttinen, Tuomas Kerola, Solomon J. Sager, Harri A. Rissanen, Robert J Myerburg, Antti Reunanen, Heikki V. Huikuri

Research output: Contribution to journalArticle

284 Citations (Scopus)

Abstract

Background-: Early repolarization (ER) in inferior/lateral leads of standard ECGs increases the risk of arrhythmic death. We tested the hypothesis that variations in the ST-segment characteristics after the ER waveforms may have prognostic importance. Methods and Results-: ST segments after ER were classified as horizontal/descending or rapidly ascending/upsloping on the basis of observations from 2 independent samples of young healthy athletes from Finland (n=62) and the United States (n=503), where ascending type was the dominant and common form of ER. Early repolarization was present in 27/62 (44%) of the Finnish athletes and 151/503 (30%) of the US athletes, and all but 1 of the Finnish (96%) and 91/107 (85%) of US athletes had an ascending/upsloping ST variant after ER. Subsequently, ECGs from a general population of 10 864 middle-aged subjects were analyzed to assess the prognostic modulation of ER-associated risk by ST-segment variations. Subjects with ER ≥0.1 mV and horizontal/descending ST variant (n=412) had an increased hazard ratio of arrhythmic death (relative risk 1.43; 95% confidence interval 1.05 to 1.94). When modeled for higher amplitude ER (>0.2 mV) in inferior leads and horizontal/descending ST-segment variant, the hazard ratio of arrhythmic death increased to 3.14 (95% confidence interval 1.56 to 6.30). However, in subjects with ascending ST variant, the relative risk for arrhythmic death was not increased (0.89; 95% confidence interval 0.52 to 1.55). Conclusions-: ST-segment morphology variants associated with ER separates subjects with and without an increased risk of arrhythmic death in middle-aged subjects. Rapidly ascending ST segments after the J-point, the dominant ST pattern in healthy athletes, seems to be a benign variant of ER.

Original languageEnglish
Pages (from-to)2666-2673
Number of pages8
JournalCirculation
Volume123
Issue number23
DOIs
StatePublished - Jun 14 2011

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Athletes
Phenotype
Confidence Intervals
Electrocardiography
Finland
Population

Keywords

  • arrhythmia
  • electrocardiography
  • epidemiology
  • follow-up studies
  • risk factors

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Tikkanen, J. T., Junttila, M. J., Anttonen, O., Aro, A. L., Luttinen, S., Kerola, T., ... Huikuri, H. V. (2011). Early repolarization: Electrocardiographic phenotypes associated with favorable long-term outcome. Circulation, 123(23), 2666-2673. https://doi.org/10.1161/CIRCULATIONAHA.110.014068

Early repolarization : Electrocardiographic phenotypes associated with favorable long-term outcome. / Tikkanen, Jani T.; Junttila, M. Juhani; Anttonen, Olli; Aro, Aapo L.; Luttinen, Samuli; Kerola, Tuomas; Sager, Solomon J.; Rissanen, Harri A.; Myerburg, Robert J; Reunanen, Antti; Huikuri, Heikki V.

In: Circulation, Vol. 123, No. 23, 14.06.2011, p. 2666-2673.

Research output: Contribution to journalArticle

Tikkanen, JT, Junttila, MJ, Anttonen, O, Aro, AL, Luttinen, S, Kerola, T, Sager, SJ, Rissanen, HA, Myerburg, RJ, Reunanen, A & Huikuri, HV 2011, 'Early repolarization: Electrocardiographic phenotypes associated with favorable long-term outcome', Circulation, vol. 123, no. 23, pp. 2666-2673. https://doi.org/10.1161/CIRCULATIONAHA.110.014068
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 Jun 14;123(23):2666-2673. https://doi.org/10.1161/CIRCULATIONAHA.110.014068
Tikkanen, Jani T. ; Junttila, M. Juhani ; Anttonen, Olli ; Aro, Aapo L. ; Luttinen, Samuli ; Kerola, Tuomas ; Sager, Solomon J. ; Rissanen, Harri A. ; Myerburg, Robert J ; Reunanen, Antti ; Huikuri, Heikki V. / Early repolarization : Electrocardiographic phenotypes associated with favorable long-term outcome. In: Circulation. 2011 ; Vol. 123, No. 23. pp. 2666-2673.
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abstract = "Background-: Early repolarization (ER) in inferior/lateral leads of standard ECGs increases the risk of arrhythmic death. We tested the hypothesis that variations in the ST-segment characteristics after the ER waveforms may have prognostic importance. Methods and Results-: ST segments after ER were classified as horizontal/descending or rapidly ascending/upsloping on the basis of observations from 2 independent samples of young healthy athletes from Finland (n=62) and the United States (n=503), where ascending type was the dominant and common form of ER. Early repolarization was present in 27/62 (44{\%}) of the Finnish athletes and 151/503 (30{\%}) of the US athletes, and all but 1 of the Finnish (96{\%}) and 91/107 (85{\%}) of US athletes had an ascending/upsloping ST variant after ER. Subsequently, ECGs from a general population of 10 864 middle-aged subjects were analyzed to assess the prognostic modulation of ER-associated risk by ST-segment variations. Subjects with ER ≥0.1 mV and horizontal/descending ST variant (n=412) had an increased hazard ratio of arrhythmic death (relative risk 1.43; 95{\%} confidence interval 1.05 to 1.94). When modeled for higher amplitude ER (>0.2 mV) in inferior leads and horizontal/descending ST-segment variant, the hazard ratio of arrhythmic death increased to 3.14 (95{\%} confidence interval 1.56 to 6.30). However, in subjects with ascending ST variant, the relative risk for arrhythmic death was not increased (0.89; 95{\%} confidence interval 0.52 to 1.55). Conclusions-: ST-segment morphology variants associated with ER separates subjects with and without an increased risk of arrhythmic death in middle-aged subjects. Rapidly ascending ST segments after the J-point, the dominant ST pattern in healthy athletes, seems to be a benign variant of ER.",
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AU - Aro, Aapo L.

AU - Luttinen, Samuli

AU - Kerola, Tuomas

AU - Sager, Solomon J.

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