Sudden Cardiac Arrest Associated with Early Repolarization

doi:10.1056/NEJMoa071968

Volume 358:2016-2023		May 8, 2008		Number 19

Sudden Cardiac Arrest Associated with Early Repolarization

Michel Haïssaguerre, M.D., Nicolas Derval, M.D., Frederic Sacher, M.D., Laurence Jesel, M.D., Isabel Deisenhofer, M.D., Luc de Roy, M.D., Jean-Luc Pasquié, M.D., Ph.D., Akihiko Nogami, M.D., Dominique Babuty, M.D., Sinikka Yli-Mayry, M.D., Christian De Chillou, M.D., Patrice Scanu, M.D., Philippe Mabo, M.D., Seiichiro Matsuo, M.D., Vincent Probst, M.D., Ph.D., Solena Le Scouarnec, Ph.D., Pascal Defaye, M.D., Juerg Schlaepfer, M.D., Thomas Rostock, M.D., Dominique Lacroix, M.D., Dominique Lamaison, M.D., Thomas Lavergne, M.D., Yoshifusa Aizawa, M.D., Anders Englund, M.D., Frederic Anselme, M.D., Mark O'Neill, M.D., Meleze Hocini, M.D., Kang Teng Lim, M.B., B.S., Sebastien Knecht, M.D., George D. Veenhuyzen, M.D., Pierre Bordachar, M.D., Michel Chauvin, M.D., Pierre Jais, M.D., Gaelle Coureau, Ph.D., Genevieve Chene, Ph.D., George J. Klein, M.D., and Jacques Clémenty, M.D.

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ABSTRACT

Background Early repolarization is a common electrocardiographicfinding that is generally considered to be benign. Its potentialto cause cardiac arrhythmias has been hypothesized from experimentalstudies, but it is not known whether there is a clinical associationwith sudden cardiac arrest.

Methods We reviewed data from 206 case subjects at 22 centerswho were resuscitated after cardiac arrest due to idiopathicventricular fibrillation and assessed the prevalence of electrocardiographicearly repolarization. The latter was defined as an elevationof the QRS–ST junction of at least 0.1 mV from baselinein the inferior or lateral lead, manifested as QRS slurringor notching. The control group comprised 412 subjects withoutheart disease who were matched for age, sex, race, and levelof physical activity. Follow-up data that included the resultsof monitoring with an implantable defibrillator were obtainedfor all case subjects.

Results Early repolarization was more frequent in case subjectswith idiopathic ventricular fibrillation than in control subjects(31% vs. 5%, P<0.001). Among case subjects, those with earlyrepolarization were more likely to be male and to have a historyof syncope or sudden cardiac arrest during sleep than thosewithout early repolarization. In eight subjects, the originof ectopy that initiated ventricular arrhythmias was mappedto sites concordant with the localization of repolarizationabnormalities. During a mean (±SD) follow-up of 61±50months, defibrillator monitoring showed a higher incidence ofrecurrent ventricular fibrillation in case subjects with a repolarizationabnormality than in those without such an abnormality (hazardratio, 2.1; 95% confidence interval, 1.2 to 3.5; P=0.008).

Conclusions Among patients with a history of idiopathic ventricularfibrillation, there is an increased prevalence of early repolarization.

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From the Université Bordeaux, Hôpital Haut-Lévêque, Bordeaux-Pessac (M.Haïssaguerre, N.D., F.S., S.M., M. Hocini, K.T.L., S.K., P.B., P.J., G. Coureau, G. Chene, J.C.), and Centres Hospitaliers Universitaires of Strasbourg (L.J., M.C.), Montpellier (J.-L.P.), Tours (D.B.), Nancy (C.D.C.), Caen (P.S.), Rennes (P.M.), Nantes (V.P., S.L.S.), Grenoble (P.D.), Lille (D. Lacroix), Clermont-Ferrand (D. Lamaison), Paris (T.L.), and Rouen (F.A.) — all in France; Herzzentrum, Munich (I.D.), and Eppendorf Hospital, Hamburg (T.R.) — both in Germany; Clinique de Mont Godinne, Louvain, Belgium (L.R.); Yokohama Rosai Hospital, Yokohama (A.N.), and Niigata University School, Niigata (Y.A.) — both in Japan; Tampere University Hospital, Tampere, Finland (S.Y.-M.); Centre Hospitalier, Lausanne, Switzerland (J.S.); Orebro Hospital, Orebro, Sweden (A.E.); St. Mary Hospital, London (M.O.); and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary (G.D.V.), and London Health Sciences Centre, London, ON (G.J.K.) — both in Canada.

Address reprint requests to Dr. Haïssaguerre at Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France, or at michel.haissaguerre{at}chu-bordeaux.fr.

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N Engl J Med 2008; 359:761-762, Aug 14, 2008. Correspondence

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