Early Repolarization Found on Routine Electrocardiograms: Risk and Management

Early repolarization (ER) pattern is a prominent J point (end-QRS notch or slur) with an elevation ≥0.1 mV in two or more contiguous leads (excluding V1-V3) in a 12-lead electrocardiogram (ECG). Furthermore, the QRS duration is required to be <120 ms (measured in leads in which J point elevation is absent) with a symmetric concordant T wave of large amplitude (Figure).1,2 ER pattern is most commonly seen in the left lateral leads and less frequently in the inferior leads. ER syndrome, on the other hand, is diagnosed only in patients who have a history of resuscitated cardiac arrest, history of ventricular fibrillation (VF) or polymorphic ventricular tachycardia.3 ER pattern mimics the ECG patterns seen in myocardial infarction, pericarditis, ventricular aneurysm, hyperkalemia, or hypothermia. Therefore, practitioners often commit to laboratory and imaging tests, medication administration, and hospital admissions that are unnecessary because of ECG misinterpretation