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

Tsukasa Kamakura, Hiro Kawata, Ikutaro Nakajima, Yuko Yamada, Koji Miyamoto, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Takeshi Aiba, Hiroshi Takaki, Naohiko Aihara, Shiro Kamakura, Takeshi Kimura, Wataru Shimizu
Journal of the American College of Cardiology 2013 October 22, 62 (17): 1610-8

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.

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