Syncope and Early Repolarization: A Benign or Dangerous ECG Finding?

• Main Authors: Matthew McKillop, MD, FACC, FHRS, William M. Miles, MD, FACC, FHRS
• Format: Article
• Language: English
• Published: Compuscript 2016-02-01
• Series: Cardiovascular Innovations and Applications
• Subjects: syncope; early repolarization; Brugada syndrome; J wave syndrome; genetic channelopathy
• Online Access: http://www.ingentaconnect.com/content/cscript/cvia/2016/00000001/00000002/art00007

Early repolarization is a well-described, common electrocardiographic variant. It was initially felt to be benign, but in the last twenty years a suggested a link between specific types of early repolarization and sudden cardiac death has emerged. This association was has been termed the J wave syndrome and includes both the high risk early repolarization and Brugada ECG patterns. The odds of early repolarization change being associated with poor outcomes are still exceedingly small. Nevertheless, the association of a fairly ubiquitous ECG finding with fatal or near fatal clinical outcomes has raised concern. How can we identify the truly high-risk patients? If a patient has a significant clinical event with a concerning ECG repolarization pattern, what should be done next? The authors of this review present current information regarding the Early Repolarization and Brugada Syndromes and how to proceed with diagnosis, management, and risk stratification when early repolarization change is observed on ECG.