Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):714-8. doi: 10.1161/CIRCEP.112.970863. Epub 2012 Jun 22.
Electrocardiographic early repolarization (ER) pattern has been previously associated with arrhythmic mortality and with an increased risk of ventricular fibrillation. We hypothesized that there is an association between ER and sudden cardiac death (SCD) during an acute coronary event.
The present study included 432 consecutive victims of SCD because of acute coronary event and 532 survivors of such an event, in whom 12-lead ECGs recorded before and unrelated to the event could be evaluated. SCDs were verified by medicolegal autopsy to be because of acute coronary event. ER was defined as an elevation of the QRS-ST junction in at least 2 inferior or lateral leads, manifested as QRS notching or slurring. The prevalence of ER pattern ≥0.1 mV was more common in cases (62/432; 14.4%) than controls (42/532; 7.9%) (P=0.001). The victims of SCD were younger, were more commonly men and smokers, had lower body mass index, had elevated heart rate, had prolonged QRS complex, and had lower prevalence of history of prior cardiovascular disease than controls. After adjustments for baseline differences, the odds ratio for J waves without ST-segment elevation in the SCD group was 2.15 (95% CI, 1.20-3.85; P=0.01).
Higher prevalence of ER in a standard 12-lead ECG in victims of SCD than in survivors of an acute coronary event suggests that the presence of ER increases the vulnerability to fatal arrhythmia during acute myocardial ischemia and provides a plausible mechanistic link between this ECG pattern and higher arrhythmic mortality of middle-aged/elderly subjects.
心电图早期复极（ER）模式先前与心律失常性死亡率和室颤风险增加相关。我们假设 ER 与急性冠状动脉事件期间的心脏性猝死（SCD）之间存在关联。
本研究纳入了 432 例因急性冠状动脉事件导致的 SCD 连续受害者和 532 例该事件幸存者，其中可评估事件发生前记录的 12 导联心电图且与事件无关。通过法医解剖验证 SCD 是由于急性冠状动脉事件引起的。ER 定义为至少 2 个下壁或侧壁导联中 QRS-ST 连接抬高，表现为 QRS 切迹或模糊。病例组（62/432；14.4%）中 ER 模式≥0.1 mV 的发生率高于对照组（42/532；7.9%）（P=0.001）。SCD 受害者年龄更小，更常见于男性和吸烟者，体重指数较低，心率较快，QRS 复合波延长，既往心血管疾病史的发生率较低。在调整基线差异后，SCD 组无 ST 段抬高 J 波的优势比为 2.15（95%置信区间，1.20-3.85；P=0.01）。
SCD 受害者标准 12 导联心电图中 ER 的发生率高于急性冠状动脉事件幸存者，表明 ER 的存在增加了急性心肌缺血时致命性心律失常的易感性，并为这种心电图模式与中老年人更高的心律失常死亡率之间提供了合理的机制联系。
