CARDIAC BOOTCAMP
  • HOME
  • Course Login
    • Log In
    • Log Out
  • SYLLABUS
  • STORE
    • Online Self Study Course
    • Cardiac Video Course
  • ECG OF THE WEEK

ECG OF THE WEEK

BECOME A COURSE MEMBER
Each Week we put up one ECG case for you....because it's easier to learn from cases.
The ECG of the week is FREE to everyone. To become an expert at ECG's join the Cardiac Bootcamp Course. It's a great way to Learn!
​Or come to one of our LIVE Cardiac Bootcamps

IS early depolarisation benign?

6/3/2023

0 Comments

 
This Blog was originally published on resus.com.au
Is Early Depolarisation benign? Several years ago we began to challenge this belief. Certainly in athletes it may be, however in the general population there has been an association with sudden cardiac death. Now ‘Hot of the Press’ is a new study reviewing the literature. In most cases early depolarisation is benign, however, there are cases where it has been associated with polymorphic ventricular tachycardia and ventricular fibrillation.
Below we look at the patterns that allow us to determine when it might be dangerous.

What is Early Repolarisation?
It is an electrocardiographic pattern (Fig 1) defined as:
  • J-point elevation of at least 1mm in > 1 inferior lead (II, III and aVF) and/or Lateral lead (I, aVL and V4-6) with either:
  • QRS slurring (smooth progression of terminal QRS to ST segment) or
  • Notching (positive deflection of S wave)
Picture
Characteristics of the dangerous pattern
There is an increased risk of arrhythmias and sudden cardiac death when:
  1. It occurs in young males
  2. There is a history of syncope. More than 25% of patients with early repolarisation had an episode of syncope
  3. Inferior early repolarisation patterns are associated with a greater risk of ventricular arrhythmias
  4. Particular ECG morphologies were associated with increased risk
    1. ST Segment Morphology: Higher arrhythmic risk occurred in those patients with
      1. Horizontal/descending ST-Segment in the inferior leads
        1. When combined with a >2mm J-point elevation, the risk is even higher.
      2. Notching of the terminal portion of the QRS is associated with a higher arrhythmic risk
    2. J-point Amplitude, Duration and Slope (Fig 2)
      1. J-point elevation of at least 2mm was associated with a higher risk of death
      2. J-point duration is defined as the distance from J-point onset to where the Jpoint’s tangent intersects the isoelectric line. A longer duration increased the arrhythmic risk. In one study duration was 69.48 vs 35.05 ms.
      3. The J angle is the angle between an ideal line formed from the jpoint perpendicular to the isoelectric line and the tangent to the J wave. A wider angle (usually > 30 degrees) increases arrhythmic risk.
    3. T wave Morphology
      1. Usually T waves had low amplitude
      2. There was a low T wave/R wave ratio in leads II and V5 (Fig 3)
    4. Q waves and T wave inversions were also found to contribute to arrhythmic risk.
    5. There may be an association with coronary artery disease and other channelopathies.
Picture
Picture
Management of Patients with Early Depolarisation
Most patients with isolated early repolarisation require no treatment. Patients who require an implantable defibrillator include:
  • Patients surviving ventricular arrhythmias
  • Patients with a family history of sudden cardiac death and early repolarisation patterns
  • Patients with syncope and early repolarisation
  • Those with high risk ECG patterns as discussed above.


References
El-Azrak M et al. Sudden Cardiac Death Risk Stratification of the Early Repolarization Syndrome: An Updated Review of the Literature.
0 Comments



Leave a Reply.

    Author

    Dr Peter Kas
    ​Emergency Physician

    Back to resus.com.au
    Picture
    Picture
    Sign up for
    ECG of the week
     Its free

    Archives

    May 2023
    March 2023
    February 2023
    January 2023
    December 2022
    November 2022
    October 2022
    September 2022
    August 2022
    July 2022
    June 2022
    March 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    September 2020
    August 2020
    July 2020

    Categories

    All
    Ablation
    Atrial Fibrillation
    Atrial Flutter
    Atrial Tachycardia
    Axis
    Bradycardia
    Cardiac Arrest
    Chest Pain
    ECG Mimics
    Ischaemia
    Lead Reversal
    Migraine
    Myopericarditis
    Pacing
    Paediatric Arrhythmias
    Paediatric ECG
    Paediatric Syncope
    Pericarditis
    QT Interval
    STEMI
    STEMI Mimics
    SVT
    T Waves
    Ventricular Tachycardia
    Wellens
    Wide Complex Tachycardia

Our Other Websites to Visit

www.emcore.com.au
www.resus.com.au

Contact Us
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
  • HOME
  • Course Login
    • Log In
    • Log Out
  • SYLLABUS
  • STORE
    • Online Self Study Course
    • Cardiac Video Course
  • ECG OF THE WEEK