A Clinical Approach to Early Repolarization
A Clinical Approach to Early Repolarization
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早期复极的临床方法
作者：
M. Obeyesekere;G. Klein;S. Nattel;P. Leong‐Sit;L. Gula;A. Skanes;R. Yee;A. Krahn
术语早期复极（ER）在心电图上定义为（1）ST段起始处的正QRS波群之后立即出现清晰的正向偏转或切迹，或（2）QRS波群末端部分模糊（也称为J波或J点抬高，图1）。具体而言，当在2个相邻导联中观察到J点升高≥0.1 mV且形态模糊或有缺口时，则存在ER模式。1，2尽管ER在历史上被认为是良性的，但随着许多研究1 -5确定了死亡和特发性室颤（VF）风险增加的相关性，这种看法发生了变化。早期复极的偶然发现现在提出了许多问题，包括定义和量化猝死的风险。随着遗传贡献的报告不断出现，定义遗传基础，遗传和筛选亲属的作用扩大了早期复极的影响，超出了索引的情况。对早期复极的分子机制和治疗策略的深入了解继续突出其不断发展的意义。
图1.
明显的早期复极表现为2个相邻导联的下J点模糊和侧J点切迹均>2 mm。
本综述旨在提供一个简明扼要的总结，目前的证据围绕这些问题，上下文其临床意义，并提出了一种方法，这些患者的临床评价和管理。这篇综述将强调，大多数ER患者没有或只有很小的风险发生糖尿病事件。在其他情况下，ER底物可能潜在地增加与潜在心脏病理学相关的心脏病风险。临床医生很少会遇到ER是原发性致瘤性疾病表现的个体。
第一项严重质疑ER是良性现象这一传统的研究将206例特发性VF患者与412例健康受试者进行了比较，1并证明了ER是一种良性现象。
The term early repolarization (ER) is defined electrocardiographically by either (1) a sharp well-defined positive deflection or notch immediately following a positive QRS complex at the onset of the ST-segment, or (2) slurring at the terminal part of the QRS complex (also termed J-waves or J-point elevation, Figure 1). Specifically, the ER pattern is present when J-point elevation of ≥0.1 mV is seen in 2 adjacent leads with either a slurred or notched morphology.1,2 Although ER was historically considered benign, this perception changed as numerous studies1–5 established an association with increased risk of death and idiopathic ventricular fibrillation (VF). The incidental discovery of early repolarization now poses numerous questions, including defining and quantitating the risk of sudden death. With the emerging reports of a genetic contribution, defining the genetic basis, inheritance, and the role of screening relatives broadens the implications of early repolarization beyond the index case. Insights into the molecular mechanism of early repolarization and therapeutic strategies continue to highlight its evolving significance.
Figure 1.
Prominent early repolarization manifest as inferior J-point slurring and lateral J-point notching each >2 mm in 2 contiguous leads.
This review seeks to provide a concise summary of the current evidence surrounding these issues, contextualize its clinical significance, and present an approach to the clinical evaluation and management of these patients. This review will emphasize that the majority of individuals with ER are at no or minimal risk for arrhythmic events. In others the ER substrate may potentially increase arrhythmic risk associated with underlying cardiac pathology. Very rarely, clinicians will encounter individuals in whom ER is a manifestation of a primary arrhythmogenic disorder.
The first study to seriously question the convention that ER is a benign phenomenon compared 206 patients with idiopathic VF with 412 healthy subjects,1 and demonstrated …
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影响因子：
5.5
作者：
Burashnikov, Elena;Pfeiffer, Ryan;Barajas-Martinez, Hector;Delpon, Eva;Hu, Dan;Desai, Mayurika;Borggrefe, Martin;Haeissaguerre, Michel;Kanter, Ronald;Pollevick, Guido D.;Guerchicoff, Alejandra;Laino, Ruben;Marieb, Mark;Nademanee, Koonlawee;Nam, Gi-Byoung;Robles, Roberto;Schimpf, Rainer;Stapleton, Dwight D.;Viskin, Sami;Winters, Stephen;Wolpert, Christian;Zimmern, Samuel;Veltmann, Christian;Antzelevitch, Charles
通讯作者：
Antzelevitch, Charles
使用术语J波综合征和早期重极化的理由。
影响因子：
24
作者：
Antzelevitch, Charles;Yan, Gan-Xin;Viskin, Sami
通讯作者：
Viskin, Sami
影响因子：
24
作者：
Noseworthy, Peter A.;Tikkanen, Jani T.;Porthan, Kimmo;Oikarinen, Lasse;Pietila, Arto;Harald, Kennet;Peloso, Gina M.;Merchant, Faisal M.;Jula, Antti;Vaananen, Heikki;Hwang, Shih-Jen;O'Donnell, Christopher J.;Salomaa, Veikko;Newton-Cheh, Christopher;Huikuri, Heikki V.
通讯作者：
Huikuri, Heikki V.
影响因子：
5.5
作者：
Barajas-Martinez, Hector;Hu, Dan;Ferrer, Tania;Onetti, Carlos G.;Wu, Yuesheng;Burashnikov, Elena;Boyle, Madalene;Surman, Tyler;Urrutia, Janire;Veltmann, Christian;Schimpf, Rainer;Borggrefe, Martin;Wolpert, Christian;Ibrahim, Bassiema B.;Antonio Sanchez-Chapula, Jose;Winters, Stephen;Haissaguerre, Michel;Antzelevitch, Charles
通讯作者：
Antzelevitch, Charles
DOI：
10.1253/circj.cj-12-0284
发表时间：
2012
期刊：
Circulation journal : official journal of the Japanese Circulation Society
影响因子：
--
作者：
Antzelevitch C
通讯作者：
Antzelevitch C