Benign early repolarization (BER) orearly repolarization is found on anelectrocardiogram (ECG) in about 1% of those withchest pain.[2] It is diagnosed based on an elevatedJ-point /ST elevation with an end-QRS notch or end-QRS slur and where the ST segment concave up. It is believed to be a normal variant.[2]
Benign early repolarization that occurs as some patterns is associated withventricular fibrillation. The association, revealed by research performed in the late 2000s, is very small.
Research in the late 2000s has linked this finding toventricular fibrillation, particularly in those who havefainted or have a family history ofsudden cardiac death.[5][6][7] Although there is a significant relationship betweenventricular fibrillation and some early repolarization's patterns, the overall lifetime occurrence of idiopathic ventricular fibrillation is exceptionally rare.[8] There has also been an association between early repolarization andshort QT syndrome.[9]
On anelectrocardiogram (EKG or ECG), benign early repolarization may produce an elevation of theJ-point andST segment in 2 or more leads, similar to that observed in heart attacks (myocardial infarction). However, with benign early repolarization, the ST segment is usually concave up, rather than concave down (as with heart attacks), and there is a notable absence of reciprocal changes suggestive ofischemia on the EKG.
It is thought that the mechanism causing early repolarization is a more excitableion channel system, which causes a faster myocardium contraction.[13] Studies have shown that highertestosterone levels in males result in an increased outward potassium currents causing J-point elevation.[15]
Benign early repolarization occurs in about 1 to 13 percent of the general population with a significant increase in occurrence within athletes and adolescents.[1] In one study, an occurrence of early repolarization was observed in 31.6% of elite athletes while in another study occurrence was observed in 25.1% of athletes.[16][17]
Being a male is strongly associated with early repolarization ECG pattern, and 70% of subjects with early repolarization are males. Prevalence of early repolarization declines in males from early adulthood until middle-age which could suggest a hormonal influence on its presence. Early repolarization patterns are more common in physically active younger individuals, athletes andAfricans.[18]
Early repolarization with ST segment elevation was first described in 1936 by R.A. Shipley and W.R. Hallaran in a study of 200 healthy 20–35 year old people.[14][21]
^Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. (October 2013). "Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes".Europace.15 (10):1389–1406.doi:10.1093/europace/eut272.PMID23994779.
^Watanabe H, Makiyama T, Koyama T, Kannankeril PJ, Seto S, Okamura K, et al. (May 2010). "High prevalence of early repolarization in short QT syndrome".Heart Rhythm.7 (5):647–652.doi:10.1016/j.hrthm.2010.01.012.PMID20206319.
^abcJunttila MJ, Sager SJ, Tikkanen JT, Anttonen O, Huikuri HV, Myerburg RJ (November 2012). "Clinical significance of variants of J-points and J-waves: early repolarization patterns and risk".European Heart Journal.33 (21):2639–2643.doi:10.1093/eurheartj/ehs110.PMID22645193.
^Haïssaguerre M, Chatel S, Sacher F, Weerasooriya R, Probst V, Loussouarn G, et al. (January 2009). "Ventricular fibrillation with prominent early repolarization associated with a rare variant of KCNJ8/KATP channel".Journal of Cardiovascular Electrophysiology.20 (1):93–98.doi:10.1111/j.1540-8167.2008.01326.x.PMID19120683.S2CID21002962.
^Shipley RA, Hallaran W (1936-03-01). "The four-lead electrocardiogram in two hundred normal men and women".American Heart Journal.11 (3):325–345.doi:10.1016/S0002-8703(36)90417-9.
Junttila MJ, Sager SJ, Tikkanen JT, Anttonen O, Huikuri HV, Myerburg RJ (November 2012). "Clinical significance of variants of J-points and J-waves: early repolarization patterns and risk".European Heart Journal.33 (21):2639–2643.doi:10.1093/eurheartj/ehs110.PMID22645193.
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