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Sudden Cardiac Death and Channelopathies

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Front. Cardiovasc. Med. | doi: 10.3389/fcvm.2018.00169

Early repolarization syndrome: Diagnostic and therapeutic approach

 Felix Bourier1*, Arnaud Denis1,  Ghassen Cheniti1,  Anna Lam1,  Konstantinos Vlachos1, Masateru Takigawa1,  Takeshi Kitamura1, Antonio Frontera1,  Josselin Duchateau1, Thomas Pambrun1, Nicolas Klotz1, Nicolas Derval1,  Frederic Sacher1, Pierre Jais1, Michel Haissaguerre1 and  Mélèze Hocini1
  • 1Hôpital Cardiologique du Haut-Lévêque, France

An early repolarization pattern can be observed in 1% up to 13% of the overall population. Whereas this pattern was associated with a benign outcome for many years, several more recent studies demonstrated an association between early repolarization and sudden cardiac death, so-called early repolarization syndrome. In early repolarization syndrome patients, current imbalances between epi- and endocardial layers result in dispersion of de- and repolarization. As a consequence, J waves or ST segment elevations can be observed on these patients’ surface ECGs as manifestations of those current imbalances. Whereas an early repolarization pattern is relatively frequently found on surface ECGs in the overall population, the majority of individuals presenting with an early repolarization pattern will remain asymptomatic and the isolated presence of an early repolarization pattern does not require further intervention. The mismatch between frequently found early repolarization patterns in the overall population, low incidences of sudden cardiac deaths related to early repolarization syndrome, but fatal, grave consequences in affected patients remains a clinical challenge. More precise tools for risk stratification and identification of this minority of patients, who will experience events, remain a clinical need. This review summarizes the epidemiologic, pathophysiologic and diagnostic background and presents therapeutic options of early repolarization syndrome.

Keywords: Early repolarization syndrome (ERS), Sudden cardiac death (SCD), J wave, ICD implantation, idiopathic ventricular fibrillation

Received: 07 Aug 2018; Accepted: 05 Nov 2018.

Edited by:

Pedro Brugada, Independent researcher

Reviewed by:

Osmar A. Centurion, Universidad Nacional de Asunción, Paraguay
Valeria Novelli, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Italy  

Copyright: © 2018 Bourier, Denis, Cheniti, Lam, Vlachos, Takigawa, Kitamura, Frontera, Duchateau, Pambrun, Klotz, Derval, Sacher, Jais, Haissaguerre and Hocini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Felix Bourier, Hôpital Cardiologique du Haut-Lévêque, Pessac, Aquitaine, France, fbourier@gmail.com