Early Repolarization in Athletes: A Review.

Early repolarization (ER) on ECG was initially described in 1936 and has been considered a benign ECG finding for more than half a century.1,2 However, in 2008, a seminal study by Haissaguerre et al3 challenged this view by demonstrating an association between ER and an increased risk of idiopathic ventricular fibrillation (VF). To reconcile these apparently contradictory views, as well as to better understand the potential implication of ER in athletes, it is necessary to first understand the semantic confusion that has arisen around the term ER.4 The original definition of ER is based on ≥0.1-mV concave ST-segment elevation (STE), with or without accompanying J waves (defined as a deflection after the QRS that seems as a late delta wave or a small secondary R wave), in ≥2 anterolateral leads (Figure 1A and 1B). This ECG pattern is present in 1% to 2% of the general population, with a higher prevalence in young athletes and blacks. Historically, it has chiefly constituted a benign differential diagnosis to STE myocardial infarction and pericarditis.5 In fact, several large recent studies have confirmed that this type of ER carries no negative prognostic implications in the general population.6,7 Indeed, because ER is so common in young athletes, some have even considered it an ECG sign of good health.2 For the purpose of this review, we will refer to this type of ER as benign ER. Figure 1. Examples of the original benign and new malignant definitions of early repolarization. A and B , Original definition based on ST-segment elevation (STE), with or without J waves. New definition, based on J-wave slurring ( C ) and notching ( D ) followed by a horizontal or downsloping ST segment. Reprinted from Perez et al4 with permission of the publisher. The emerging definition …