Kukla Peter, Jastrzębski Marek, Pérez-Riera Andrés Ricardo
Department of Cardiology and Internal Medicine, Specialistic Hospital, Gorlice, Poland.
First Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital, Cracow, Poland.
Ann Noninvasive Electrocardiol. 2015 Sep;20(5):409-18. doi: 10.1111/anec.12263. Epub 2015 Mar 10.
Controversy has followed the groundbreaking and cornerstone paper of Haïssaguerre et al. Much of this controversy has been due to the use of the term "early repolarization pattern" and possible waveform morphologies on the standard 12-lead ECG ( it is 10 second strip) that could predict who will manifest the malignant arrhythmogenic syndrome described by Haïssaguerre et al. The standard ECG definition of early repolarization pattern (ERP) or early repolarization variant (ERV) since then has changed its clinical meaning for a surface electrocardiographic waveform from benign to malignant. The new definition of ERP/ERV contains only J wave but ST-segment elevation is no more obligatory. In the old definition, early repolarization pattern (ERP) or early repolarization variant (ERV) 3 is a well-recognized idiopathic electrocardiographic phenomenon considered to be present when at least two adjacent precordial leads show elevation of the ST segment, with values equal or higher than 1 mm. In the new electrocardiographic ERP concept, the ST segment may or may not be elevated and can be up-sloping, horizontal or down-sloping while in the old ERP/ERV concept it must be elevated at least 1 mm in at least two adjacent leads and the variant is characterized by a diffuse elevation of the ST segment of upper concavity, ending in a positive T wave of V2 to V4 or V5 and prominent J wave and ST-segment elevation predominantly in left precordial leads. The phenomenon constitutes a normal variant; it is almost a rule in athletes (present in 89% of the cases in this universe).
海萨盖尔等人具有开创性的基础性论文引发了诸多争议。其中许多争议源于“早期复极模式”这一术语的使用，以及标准12导联心电图（10秒记录条）上可能出现的波形形态，这些波形形态能够预测谁会表现出海萨盖尔等人所描述的恶性心律失常综合征。自那时起，早期复极模式（ERP）或早期复极变异（ERV）的标准心电图定义已将其对于体表心电图波形的临床意义从良性转变为恶性。ERP/ERV的新定义仅包含J波，而ST段抬高不再是必需的。在旧定义中，早期复极模式（ERP）或早期复极变异（ERV）3是一种公认的特发性心电图现象，当至少两个相邻胸前导联的ST段抬高，且抬高值等于或高于1毫米时被认为存在。在新的心电图ERP概念中，ST段可能抬高也可能不抬高，且可以是上斜型、水平型或下斜型，而在旧的ERP/ERV概念中，它必须在至少两个相邻导联中至少抬高1毫米，并且该变异的特征是ST段呈向上凹面的弥漫性抬高，在V2至V4或V5导联以正向T波结束，伴有明显的J波和主要在左胸前导联的ST段抬高。这种现象构成一种正常变异；在运动员中几乎是普遍存在的（在该群体中89%的病例中出现）。
