Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease

Ravi B. Patel, Jason Ng, Vikram Reddy, Moulin Chokshi, Kishan Parikh, Haris Subacius, Alawi A. Alsheikh-Ali, Tuan Nguyen, Mark S. Link, Jeffrey J. Goldberger, Leonard Ilkhanoff, Alan H. Kadish

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background-Early repolarization, indicated on the standard 12-lead ECG, has recently been associated with idiopathic ventricular fibrillation in patients without structural heart disease. It is unknown whether there is an association between early repolarization and ventricular arrhythmias in the coronary artery disease (CAD) population. Methods and Results-Patients with CAD with implantable cardioverter-defibrillators in the healed phase of myocardial infarction were analyzed. In a case-control design, 60 patients who had ventricular arrhythmic events were matched for age and sex with 60 control subjects. ECGs were analyzed for early repolarization, defined as notching or slurring morphology of the terminal QRS complex or J-point elevation ≥0.1 mV above baseline in at least 2 lateral or inferior leads. Results were adjusted for left ventricular ejection fraction. Overall, early repolarization in 2 or more leads was more common in cases than control subjects (32% versus 8%, P=0.005). Early repolarization was noted more commonly in inferior leads (23% versus 8%, P=0.03), and a trend was noted in leads V4 through V6 (12% versus 3%, P=0.11). Early repolarization was uncommon in leads I and aVL in cases and control subjects (3% versus 0%). Notching was more common in cases than control subjects (28% versus 7%, P=0.008). Slurring and J-point elevation were not associated with ventricular arrhythmias. Conclusions-Early repolarization and, in particular, notching in the inferior leads is associated with increased risk of life-threatening ventricular arrhythmias in patients with CAD, even after adjustment for left ventricular ejection fraction. Our findings suggest early repolarization, and a notching morphology should be considered in a risk prediction model for arrhythmias in patients with CAD.

Original languageEnglish (US)
Pages (from-to)489-495
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume3
Issue number5
DOIs
StatePublished - Oct 1 2010

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Cardiac Arrhythmias
Coronary Artery Disease
Stroke Volume
Electrocardiography
Implantable Defibrillators
Heart Diseases
Myocardial Infarction
Population

Keywords

  • Arrhythmia
  • Coronary disease
  • Electrocardiography
  • Fibrillation
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease. / Patel, Ravi B.; Ng, Jason; Reddy, Vikram; Chokshi, Moulin; Parikh, Kishan; Subacius, Haris; Alsheikh-Ali, Alawi A.; Nguyen, Tuan; Link, Mark S.; Goldberger, Jeffrey J.; Ilkhanoff, Leonard; Kadish, Alan H.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 3, No. 5, 01.10.2010, p. 489-495.

Research output: Contribution to journalArticle

Patel, RB, Ng, J, Reddy, V, Chokshi, M, Parikh, K, Subacius, H, Alsheikh-Ali, AA, Nguyen, T, Link, MS, Goldberger, JJ, Ilkhanoff, L & Kadish, AH 2010, 'Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease', Circulation: Arrhythmia and Electrophysiology, vol. 3, no. 5, pp. 489-495. https://doi.org/10.1161/CIRCEP.109.921130
Patel, Ravi B. ; Ng, Jason ; Reddy, Vikram ; Chokshi, Moulin ; Parikh, Kishan ; Subacius, Haris ; Alsheikh-Ali, Alawi A. ; Nguyen, Tuan ; Link, Mark S. ; Goldberger, Jeffrey J. ; Ilkhanoff, Leonard ; Kadish, Alan H. / Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease. In: Circulation: Arrhythmia and Electrophysiology. 2010 ; Vol. 3, No. 5. pp. 489-495.
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abstract = "Background-Early repolarization, indicated on the standard 12-lead ECG, has recently been associated with idiopathic ventricular fibrillation in patients without structural heart disease. It is unknown whether there is an association between early repolarization and ventricular arrhythmias in the coronary artery disease (CAD) population. Methods and Results-Patients with CAD with implantable cardioverter-defibrillators in the healed phase of myocardial infarction were analyzed. In a case-control design, 60 patients who had ventricular arrhythmic events were matched for age and sex with 60 control subjects. ECGs were analyzed for early repolarization, defined as notching or slurring morphology of the terminal QRS complex or J-point elevation ≥0.1 mV above baseline in at least 2 lateral or inferior leads. Results were adjusted for left ventricular ejection fraction. Overall, early repolarization in 2 or more leads was more common in cases than control subjects (32{\%} versus 8{\%}, P=0.005). Early repolarization was noted more commonly in inferior leads (23{\%} versus 8{\%}, P=0.03), and a trend was noted in leads V4 through V6 (12{\%} versus 3{\%}, P=0.11). Early repolarization was uncommon in leads I and aVL in cases and control subjects (3{\%} versus 0{\%}). Notching was more common in cases than control subjects (28{\%} versus 7{\%}, P=0.008). Slurring and J-point elevation were not associated with ventricular arrhythmias. Conclusions-Early repolarization and, in particular, notching in the inferior leads is associated with increased risk of life-threatening ventricular arrhythmias in patients with CAD, even after adjustment for left ventricular ejection fraction. Our findings suggest early repolarization, and a notching morphology should be considered in a risk prediction model for arrhythmias in patients with CAD.",
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AU - Patel, Ravi B.

AU - Ng, Jason

AU - Reddy, Vikram

AU - Chokshi, Moulin

AU - Parikh, Kishan

AU - Subacius, Haris

AU - Alsheikh-Ali, Alawi A.

AU - Nguyen, Tuan

AU - Link, Mark S.

AU - Goldberger, Jeffrey J.

AU - Ilkhanoff, Leonard

AU - Kadish, Alan H.

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N2 - Background-Early repolarization, indicated on the standard 12-lead ECG, has recently been associated with idiopathic ventricular fibrillation in patients without structural heart disease. It is unknown whether there is an association between early repolarization and ventricular arrhythmias in the coronary artery disease (CAD) population. Methods and Results-Patients with CAD with implantable cardioverter-defibrillators in the healed phase of myocardial infarction were analyzed. In a case-control design, 60 patients who had ventricular arrhythmic events were matched for age and sex with 60 control subjects. ECGs were analyzed for early repolarization, defined as notching or slurring morphology of the terminal QRS complex or J-point elevation ≥0.1 mV above baseline in at least 2 lateral or inferior leads. Results were adjusted for left ventricular ejection fraction. Overall, early repolarization in 2 or more leads was more common in cases than control subjects (32% versus 8%, P=0.005). Early repolarization was noted more commonly in inferior leads (23% versus 8%, P=0.03), and a trend was noted in leads V4 through V6 (12% versus 3%, P=0.11). Early repolarization was uncommon in leads I and aVL in cases and control subjects (3% versus 0%). Notching was more common in cases than control subjects (28% versus 7%, P=0.008). Slurring and J-point elevation were not associated with ventricular arrhythmias. Conclusions-Early repolarization and, in particular, notching in the inferior leads is associated with increased risk of life-threatening ventricular arrhythmias in patients with CAD, even after adjustment for left ventricular ejection fraction. Our findings suggest early repolarization, and a notching morphology should be considered in a risk prediction model for arrhythmias in patients with CAD.

AB - Background-Early repolarization, indicated on the standard 12-lead ECG, has recently been associated with idiopathic ventricular fibrillation in patients without structural heart disease. It is unknown whether there is an association between early repolarization and ventricular arrhythmias in the coronary artery disease (CAD) population. Methods and Results-Patients with CAD with implantable cardioverter-defibrillators in the healed phase of myocardial infarction were analyzed. In a case-control design, 60 patients who had ventricular arrhythmic events were matched for age and sex with 60 control subjects. ECGs were analyzed for early repolarization, defined as notching or slurring morphology of the terminal QRS complex or J-point elevation ≥0.1 mV above baseline in at least 2 lateral or inferior leads. Results were adjusted for left ventricular ejection fraction. Overall, early repolarization in 2 or more leads was more common in cases than control subjects (32% versus 8%, P=0.005). Early repolarization was noted more commonly in inferior leads (23% versus 8%, P=0.03), and a trend was noted in leads V4 through V6 (12% versus 3%, P=0.11). Early repolarization was uncommon in leads I and aVL in cases and control subjects (3% versus 0%). Notching was more common in cases than control subjects (28% versus 7%, P=0.008). Slurring and J-point elevation were not associated with ventricular arrhythmias. Conclusions-Early repolarization and, in particular, notching in the inferior leads is associated with increased risk of life-threatening ventricular arrhythmias in patients with CAD, even after adjustment for left ventricular ejection fraction. Our findings suggest early repolarization, and a notching morphology should be considered in a risk prediction model for arrhythmias in patients with CAD.

KW - Arrhythmia

KW - Coronary disease

KW - Electrocardiography

KW - Fibrillation

KW - Tachycardia

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