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Prevalence of early repolarisation/J wave patterns in the normal population

2013; Elsevier BV; Volume: 46; Issue: 5 Linguagem: Inglês

10.1016/j.jelectrocard.2013.06.014

1532-8430

Philippe Maury, Anne Rollin,

ECG Monitoring and Analysis

Whatever the terminology which will be further used, either early (ER), Haissaguerre or J wave syndrome, it should never be forgotten that the ECG pattern associating various degrees of J point elevation, slurring or notching of the terminal part of the QRS and further ST elevation has been described well before the recent growing interest of electrophysiologists for this entity and was and should be still considered – as a normal ECG variant, at least in the very largest part of the normal population. Although this introductive assumption is far from original, it is worth to be recalled, because we should never lose sight of a feature that is present in several percent of the normal population cannot be considered as abnormal. Historically, one can track the first description of this pattern as soon as 1936, followed by some other reports over the last half of the previous century. At this step, the pattern was essentially described as ST elevation with a distinct notch or slur on the downslope of the R wave and was described as a “normal variant”, “unusual RT segment deviation”, “normal RST elevation variant” related to a “persistent juvenile pattern”, reflecting the belief of lack of any harmful consequence carried by this ECG pattern at this time. The clinical relevance of the documentation of this ECG pattern in a given patient however is not negligible, since it may mimick pericarditis, acute myocardial infarction or hypothermia for example, and may be associated, although in a very limited subset of patients, to sudden death (see other chapters from this issue). If we now carefully look at the publications relying on the prevalence of “early repolarization pattern in the normal population, we can see that very various rates have been observed (roughly 1–15% according to most of the studies compiled in Table 2). These rather large differences are believed to reflect some differences in the definition (ST elevation or J wave) or methods to diagnose the pattern (manual vs automatic analysis for example), as well as differences in the studied population. Moreover, for some authors the QRS possibly includes the J wave/slurring – so