Yakkali Shreyas, Teresa Selvin Sneha, Thomas Sonu, Bikeyeva Viktoriya, Abdullah Ahmed, Radivojevic Aleksandra, Abu Jad Anas A, Ravanavena Anvesh, Ravindra Chetna, Igweonu-Nwakile Emmanuelar O, Ali Safina, Paul Salomi, Hamid Pousette
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Behavioral Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2022 Jul 13;14(7):e26820. doi: 10.7759/cureus.26820. eCollection 2022 Jul.
The last two decades have changed the viewpoint on early repolarization syndrome (ERS). The prevalence of the early repolarization pattern is variable and ranges between 3-24% depending upon age, gender, and criteria used for J-point upliftment from baseline (0.05mV vs. 1 mV). While this pattern was previously linked with a benign result, multiple recent investigations have found a link between early repolarization and Sudden Cardiac Death (SCD) by causing life-threatening arrhythmias like Ventricular tachycardia/Ventricular fibrillation, a condition known as early repolarization syndrome. The syndrome falls under a broader bracket of J wave syndromes, which can be caused by early repolarization or depolarization abnormalities. The characteristics of early repolarization that are considered high risk for Sudden Cardiac Death include the amplitude of J-point upliftment from baseline ( > 0.2 mV), Inferior-lateral location of Early Repolarization pattern, and horizontal and downsloping ST-segment. Patients with symptomatic early repolarisation patterns on ECG are more likely to have repeated cardiac episodes. Implantable Cardioverter-Defibrillator (ICD) implantation and isoproterenol are the recommended treatments in symptomatic patients. On the other hand, asymptomatic patients with early repolarization patterns are prevalent and have a better outcome. Risk categorization is still obscure in asymptomatic early repolarization patterns. This traditional review outlines the known knowledge of pathophysiology behind the increased risk of sudden cardiac death, risk stratification of patients with ERS, and the treatment guidelines for patients with ERS. Further prospective studies are recommended to elucidate the exact mechanism for ventricular arrhythmogenesis in ERS patients and to risk stratifying asymptomatic patients with ERS.
过去二十年改变了人们对早期复极综合征（ERS）的看法。早期复极模式的患病率各不相同，根据年龄、性别以及用于定义J点相对于基线抬高的标准（0.05mV与1mV），其范围在3%至24%之间。虽然这种模式以前被认为预后良好，但最近多项研究发现，早期复极与心源性猝死（SCD）之间存在关联，它会引发危及生命的心律失常，如室性心动过速/室颤，这种情况被称为早期复极综合征。该综合征属于J波综合征这一更广泛的范畴，J波综合征可由早期复极或去极化异常引起。被认为有较高心源性猝死风险的早期复极特征包括J点相对于基线的抬高幅度（>0.2mV）、早期复极模式的下侧壁位置以及水平和下斜型ST段。心电图上有症状性早期复极模式的患者更有可能反复出现心脏问题。对于有症状的患者，推荐植入植入式心脏复律除颤器（ICD）和使用异丙肾上腺素进行治疗。另一方面，有早期复极模式的无症状患者很常见，且预后较好。无症状早期复极模式的风险分类仍不明确。这篇传统综述概述了心源性猝死风险增加背后的已知病理生理学知识、ERS患者的风险分层以及ERS患者的治疗指南。建议进一步开展前瞻性研究，以阐明ERS患者室性心律失常发生的确切机制，并对无症状ERS患者进行风险分层。
