Significance of non-type 1 anterior early repolarization in patients with inferolateral early repolarization syndrome

J Am Coll Cardiol. 2013 Oct 22;62(17):1610-8. doi: 10.1016/j.jacc.2013.05.081. Epub 2013 Jul 10.


Objectives: The aim of this study was to investigate the significance of non-type 1 anterior early repolarization (NT1-AER) combined with inferolateral early repolarization syndrome (ERS).

Background: Inferolateral ERS might be a heterogeneous entity, although it excludes type 1 Brugada syndrome (BS).

Methods: Of 84 patients with spontaneous ventricular fibrillation, 31 ERS patients were divided into 2 groups. The ERS(A)-group consisted of inferolateral ER and NT1-AER--that is, notching or slurring with J-wave ≥ 1 mm at the end of QRS to early ST segment in any of V1 to V3 leads, in which the ST-T segment did not change to a coved pattern in the standard and high costal (second and third) electrocardiographic recordings even after drug provocation tests (n = 12). The other, ERS(B)-group, showed only inferolateral ER (n = 19). Clinical characteristics and outcomes were compared between the ERS groups, 40 patients with type-1 BS (BS-group), and 13 patients with idiopathic ventricular fibrillation lacking J-wave (IVF-group).

Results: Ventricular fibrillation occurred during sleep or near sleep in 10 of 12 patients in ERS(A)-group and in 22 of 40 patients in BS-group but in 2 of 19 patients in ERS(B)-group and in 1 of 13 patients in IVF-group (ERS[A] vs. ERS[B], p < 0.0001). Ventricular fibrillation recurrence was significantly higher in ERS(A)-group (58%), particularly in patients with J waves in the high lateral lead, and BS-group (55%), compared with ERS(B)-group (11%) and IVF-group (15%) (ERS[A] vs. ERS[B], p = 0.012).

Conclusions: Inferolateral ERS comprises heterogeneous ER subtypes with and without NT1-AER. Coexistence of NT1-AER was a key predictor of poor outcome in patients with ERS.

Keywords: BS; Brugada syndrome; ECG; ER; ERS; ERS(A); ERS(B); ICD; IVF; J-wave; LV; NT1-AER; RV; VF; coved anterior early repolarization; coved-AER; early repolarization; early repolarization syndrome; electrocardiogram; idiopathic ventricular fibrillation; implantable cardioverter-defibrillator; inferolateral early repolarization combined with non-type 1 anterior early repolarization; left ventricle/ventricular; non-type 1 anterior early repolarization; pure inferolateral early repolarization without anterior early repolarization; right ventricle/ventricular; ventricular fibrillation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brugada Syndrome / diagnosis
  • Brugada Syndrome / mortality
  • Brugada Syndrome / physiopathology
  • Electrocardiography* / methods
  • Female
  • Follow-Up Studies
  • Heart Conduction System / physiopathology*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Retrospective Studies
  • Syndrome
  • Time Factors
  • Ventricular Fibrillation / diagnosis*
  • Ventricular Fibrillation / mortality
  • Ventricular Fibrillation / physiopathology*