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Original article
Temporal variation and morphologic characteristics of J-waves in patients with early repolarisation syndrome
  1. Hyung Oh Choi1,
  2. Gi-Byoung Nam2,
  3. Eun-Sun Jin3,
  4. Ki-Hun Kim4,
  5. Sung-Hwan Kim5,
  6. Eui-Seock Hwang6,
  7. Kyoung-Min Park7,
  8. Jun Kim2,
  9. Kyoung-Suk Rhee8,
  10. Kee-Joon Choi2,
  11. You-Ho Kim2
  1. 1Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
  2. 2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  3. 3Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
  4. 4Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
  5. 5Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, Catholic University, Seoul, Korea
  6. 6Department of Internal Medicine, MyongJi Hospital, College of Medicine, KwanDong University, GyeongGi-Do, Korea
  7. 7Department of Internal Medicine, Konkuk University Medical Center, College of Medicine, Konkuk University, Seoul, Korea
  8. 8Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University, Chonju, Republic of Korea
  1. Correspondence to Dr Gi-Byoung Nam, Department of Internal Medicine, University of Ulsan College of Medicine, Poongnap-dong 388-1, Songpa-gu, Seoul 138-736, Korea; gbnam{at}


Objective Electrocardiographic markers identifying malignant forms of early repolarisation (ER) from ER of normal variants are of prime clinical importance. We compared the ECG parameters of ER patterns in patients with early repolarisation syndrome (ERS) proximate to the ventricular fibrillation (VF) episodes, remote from the events and those with normal controls with ER.

Design A retrospective, case-control study.

Setting University hospital.

Patients This study included 12 patients with ERS and 36 age-matched, gender-matched controls with ER.

Main outcome measures Dynamic change of J-wave.

Results The highest amplitude of J-wave, sum of the J-wave amplitudes or the number of leads with ER showed a dramatic change during the perievent period. J-wave amplitudes (2.0±1.3 vs 4.0±1.7, p=0.004) and the number of leads with ER (3.3±1.7 vs 5.3±2.0, p=0.021) were significantly higher around the time of VF. In particular, the characteristic morphology of ‘giant’ (wide, >80 ms) J-waves were observed during the perievent period in 5/12 patients with ERS. However, there were no significant differences in the electrocardiographic parameters of ER pattern remote from VF events between the patients with ERS and normal control subjects with ER.

Conclusions Although the extent of and amplitude of J-wave or ST segment elevation (STE) increased significantly around VF episodes, the electrocardiographic parameters of ER remote from VF episodes were not significantly different from those of normal controls. The narrow time window of these ECG changes limits early detection of ER patients at risk of developing VF or sudden cardiac death.

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