Benign vs. malignant inferolateral early repolarization: Focus on the T wave

Heart Rhythm. 2016 Apr;13(4):894-902. doi: 10.1016/j.hrthm.2015.11.020. Epub 2015 Dec 1.


Background: Inferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF).

Objective: The purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER.

Methods: We compared the ECGs of patients with ER and VF (n = 92) with control subjects with asymptomatic ER (n = 247). We assessed J-wave amplitude, QTc interval, T-wave/R-wave (T/R) ratio in leads II and V5, and presence of low-amplitude T waves (T-wave amplitude <0.1 mV and <10% of R-wave amplitude in lead I, II, or V4-V6).

Results: Compared to controls, the VF group had longer QTc intervals (388 ms vs. 377 ms, P = .001), higher J-wave amplitudes (0.23 mV vs. 0.17 mV, P <.001), higher prevalence of low-amplitude T waves (29% vs. 3%, P <.001), and lower T/R ratio (0.18 vs. 0.30, P <.001). Logistic regression analysis demonstrated that QTc interval (odds ratio [OR] per 10 ms: 1.15, 95% confidence interval [CI} 1.02-1.30), maximal J-wave amplitude (OR per 0.1 mV: 1.68, 95% CI 1.23-2.31), lower T/R ratio (OR per 0.1 unit: 0.62, 95% CI 0.47-0.81), presence of low-amplitude T waves (OR 3.53, 95% CI 1.26-9.88). and presence of J waves in the inferior leads (OR 2.58, 95% CI 1.18-5.65) were associated with malignant ER.

Conclusion: Patients with malignant ER have a higher prevalence of low-amplitude T waves, lower T/R ratio (lead II or V5), and longer QTc interval. The combination of these parameters with J-wave amplitude and distribution of J waves may allow for improved identification of malignant ER.

Keywords: Early repolarization; Electrocardiogram; J wave; QT interval; Ventricular fibrillation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Electrocardiography*
  • Europe / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Conduction System / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Survival Rate / trends
  • Ventricular Fibrillation / diagnosis*
  • Ventricular Fibrillation / epidemiology
  • Ventricular Fibrillation / physiopathology

Supplementary concepts

  • Paroxysmal ventricular fibrillation