Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes

Heart Rhythm. 2014 Nov;11(11):1974-82. doi: 10.1016/j.hrthm.2014.07.042. Epub 2014 Aug 1.


Background: J wave/QRS slurring (early repolarization) on 12-lead ECG has been associated with increased risk for ventricular fibrillation in the absence of cardiovascular (CV) disease.

Objective: The purpose of this study was to assess the prevalence and clinical significance of J wave/QRS slurring in a large population of competitive athletes.

Methods: Seven hundred four athletes (436 males [62%], age 25 ± 5 years) free of CV disease who had engaged in 30 different sports were examined. Serial clinical, ECG, and echocardiographic evaluations were available over 1 to 18 years of follow-up (mean 6 ± 4 years).

Results: J wave was found in 102 athletes (14%) and was associated with QRS slurring in 32 (4%). It was found most commonly in anterior, lateral, and inferior leads (n = 73 [72%]), occasionally in lateral leads (n = 26 [25%]), and rarely in inferior leads (n = 3 [3%]). Most of 102 athletes (n = 86 [84%]) also showed ST-segment elevation. J wave/QRS slurring was associated with other training-related ECG changes (ie, increased R/S-wave voltages in 76%) and left ventricular (LV) morphologic remodeling (LV mass 199 ± 48 g vs 188 ± 56 g, P <.05). During follow-up, no athlete with J wave experienced cardiac event or ventricular tachyarrhythmias, or developed structural CV disease.

Conclusion: In athletes, early repolarization pattern usually is associated with other ECG changes, such as increased QRS voltages and ST-segment elevation, as well as LV remodeling, suggesting that it likely represents another benign expression of the physiologic athlete's heart. J wave (early repolarization) is common in highly trained athletes and does not convey risk for adverse cardiac events, including sudden death or tachyarrhythmias.

Keywords: Arrhythmia; Athletes; Early repolarization; Electrocardiography; J wave; Sudden death.

MeSH terms

  • Adolescent
  • Adult
  • Athletes*
  • Death, Sudden, Cardiac
  • Echocardiography
  • Electrocardiography
  • Female
  • Heart Conduction System / diagnostic imaging
  • Heart Conduction System / physiopathology*
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Ventricular Fibrillation / diagnostic imaging
  • Ventricular Fibrillation / physiopathology*