Association of early repolarization pattern and ventricular fibrillation in patients with vasospastic angina: A systematic review and meta-analysis

Clin Cardiol. 2022 May;45(5):461-473. doi: 10.1002/clc.23804. Epub 2022 Mar 7.


Background: An early repolarization (ER) pattern is a risk factor for ventricular fibrillation (VF) in patients with vasospastic angina (VSA) caused by a coronary artery spasm. However, its detailed characteristics and prognostic value for VF remain unclear. Thus, we investigated the relationship between ER and VF in patients with VSA.

Hypothesis: The ER pattern is associated with VF in patients with VSA.

Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, and Web of Science databases for eligible studies published between January 2011 and December 2020; 8 studies with 1761 patients were included in the final analysis.

Results: The ER pattern significantly predicted adverse cardiovascular events (ACEs) and VF (odds ratio [OR] = 5.13, 95% confidence interval [95% CI]: 3.16-8.35, p < .00001 and OR = 5.20, 95% CI: 3.05-8.87, p < .00001). The presence of ER in the inferior leads increased the VF risk (OR = 7.80, 95% CI: 4.04-15.05, p < .00001), regardless of the J-point morphology or type of ST-segment elevation in the ER pattern. A horizontal/descending ST-segment elevation was significantly associated with VF in patients with or without an ER pattern during a coronary spasm (OR = 2.28, 95% CI: 1.07-4.88, p = .03). However, obstructive coronary artery disease was unrelated to the ER pattern (OR = 0.82, 95% CI: 0.27-2.53, p = .73).

Conclusions: An ER pattern is significantly associated with an increased risk of ACE in patients with VSA. An inferior ER pattern with horizontal/descending ST-segment elevation confers the highest risk for VF during VSA onset. Nevertheless, the ER pattern is not associated with obstructive coronary artery disease.

Keywords: adverse cardiovascular events; early repolarization pattern; meta-analysis; vasospastic angina; ventricular fibrillation.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Arrhythmias, Cardiac / complications
  • Coronary Artery Disease* / complications
  • Coronary Vasospasm* / complications
  • Coronary Vasospasm* / diagnosis
  • Electrocardiography
  • Humans
  • Retrospective Studies
  • Spasm / complications
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / etiology