New definition of the early repolarization (end-QRS notching/slurring) pattern
A new definition of the early repolarization pattern on the basis of current knowledge is urgently needed. It is entirely feasible that another definition will emerge in the future, when further studies adopting the measurement recommendations of this paper are available.
The majority of publications at the present time (e.g., refs.1–4) adopt the amplitude of Jp in Figure 2 as the reference point for measuring J-point elevation. The following criteria are therefore proposed until further research clarifies the situation.
Early repolarization is present if all of the following criteria are met
1.There is an end-QRS notch or slur on the downslope of a prominent R-wave. If there is a notch, it should lie entirely above the baseline. The onset of a slur must also be above the baseline.
2.Jp is ≥0.1 mV in 2 or more contiguous leads of the 12-lead ECG, excluding leads V1 to V3.
3.QRS duration is <120 ms.
If the ST-segment is upward sloping and followed by an upright T-wave, the pattern should be described as “early repolarization with an ascending ST segment.”
If the ST-segment is horizontal or downward sloping, the pattern should be described as “early repolarization with a horizontal or descending ST segment.”
The leads in which the notching or slurring occurs should be used as part of the description, so that, for example, a complete report might state, “Early repolarization with descending ST-segment in leads II, III, and aVF.”
If the ST-segment is ascending in at least 2 leads in each territory and is horizontal or downward sloping in 1 lead, it should be defined as ascending and vice versa. If the ST-segment is horizontal in the inferior leads and ascending in the lateral leads, the final interpretation will depend on the extent (more leads) and the (higher) amplitude of the end QRS slur or notch, that is, on the territory where the early repolarization is most prominent.
ST-segment elevation without notching or slurring
The consensus view of the group is that ST-segment elevation in the absence of a slur or notch (Figure 4) should not be reported as early repolarization. This is in keeping with the early publications on early repolarization (6,7), which included a notch or slur as part of the description of the pattern.
Pierre Taboulet Cardiologue
Hôpital Saint-Louis (APHP)