Adler Arnon, Gollob Michael H
aDivision of Cardiology, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel bDivision of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2015 Jan;30(1):8-16. doi: 10.1097/HCO.0000000000000126.
Early repolarization has been associated in the past decade with idiopathic ventricular fibrillation and arrhythmic death. The purpose of this review is to clarify recent changes in the definition of early repolarization and provide a practical approach to patients with this electrocardiographic sign.
Recent population studies have associated early repolarization with arrhythmic death. Challenges remain, however, in interpreting the risk of the early repolarization electrocardiographic pattern, as it is a common finding in the general population with a prevalence of 3-13%. Early repolarization characteristics associated with an especially high risk include high-amplitude J-point elevation, horizontal/descending ST segment, and inferior lead location.In view of the association of early repolarization with sudden death, a syndrome termed 'early repolarization syndrome' (ERS) has been accepted as the latest 'channelopathy' in patients with cardiac arrest, pronounced early repolarization pattern, and an otherwise structurally normal heart.The physiological basis of early repolarization is thought to involve an electrical transmural gradient produced by the transient outward current. Recent genetic studies have associated mutations in genes contributing to this current and other ion channels with ERS, although definitive genetic data do not yet exist to confirm pathogenicity.
ERS patients are rare and have a high risk of recurrent cardiac events. ICD implantation and possibly quinidine are the recommended treatments in this group. Opposingly, asymptomatic individuals with early repolarization are very common and, as a group, have a good prognosis. Sudden death preventive measures in these asymptomatic patients are limited to rare and unique cases.
在过去十年中，早期复极与特发性室颤及心律失常性死亡相关。本综述的目的是阐明早期复极定义的近期变化，并为有这种心电图表现的患者提供一种实用的处理方法。
近期的人群研究已将早期复极与心律失常性死亡相关联。然而，在解释早期复极心电图模式的风险方面仍存在挑战，因为它在普通人群中很常见，患病率为3% - 13%。与特别高风险相关的早期复极特征包括高振幅J点抬高、水平/下斜型ST段以及下壁导联定位。鉴于早期复极与猝死的关联，一种称为“早期复极综合征”（ERS）的综合征已被公认为心脏骤停、明显早期复极模式且心脏结构正常的患者中的最新“通道病”。早期复极的生理基础被认为涉及由瞬时外向电流产生的电跨壁梯度。近期的基因研究已将促成该电流及其他离子通道的基因突变与ERS相关联，尽管尚无确凿的基因数据来证实其致病性。
ERS患者罕见且有较高的心脏事件复发风险。推荐对该组患者植入植入式心律转复除颤器（ICD），可能还需使用奎尼丁。相反，有早期复极的无症状个体非常常见，总体预后良好。这些无症状患者的猝死预防措施仅限于罕见的特殊情况。
