Early Repolarization Pattern Associated with Sudden Cardiac Death: Long-Term Follow-Up in Patients with Chronic Heart Failure
Article first published online: 11 FEB 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 6, pages 632–639, June 2013
How to Cite
FURUKAWA, Y., YAMADA, T., MORITA, T., IWASAKI, Y., KAWASAKI, M., KIKUCHI, A., NAITO, T., FUJIMOTO, T., OZU, K., KONDO, T., SENGOKU, K., YAMAMOTO, H., MASUYAMA, T. and FUKUNAMI, M. (2013), Early Repolarization Pattern Associated with Sudden Cardiac Death: Long-Term Follow-Up in Patients with Chronic Heart Failure. Journal of Cardiovascular Electrophysiology, 24: 632–639. doi: 10.1111/jce.12093
- Issue published online: 4 JUN 2013
- Article first published online: 11 FEB 2013
- Accepted manuscript online: 12 JAN 2013 10:04PM EST
- Manuscript Accepted: 7 JAN 2013
- Manuscript Revised: 30 DEC 2012
- Manuscript Received: 31 JUL 2012
- early repolarization;
- heart failure;
- sudden cardiac death
Early Repolarization Pattern in CHF
Identification of patients with chronic heart failure (CHF) at a risk for sudden cardiac death (SCD) is an important objective. Early repolarization pattern (ERP) is associated with ventricular fibrillation in patients without structural heart diseases. Moreover, ERP was reported to be associated with SCD in patients with old myocardial infarction in a case-control study. However, little information is available on the prognostic significance of ERP in CHF patients. Thus, we aimed to investigate whether ERP is associated with SCD in CHF patients.
Methods and Results
The study population consisted of 132 consecutive outpatients with NYHA class I, II and III congestive heart failure and radionuclide left ventricular ejection fraction less than 40%. All patients underwent the standard 12-lead electrocardiogram at enrollment, where we assessed the presence of ERP using the criteria of J-point elevation ≥ 0.1 mV in at least 2 inferior or lateral leads. The primary endpoint of this study was SCD. At enrollment, 16 patients had ERP. During the follow-up period of 6.7 ± 3.5 years, 26 patients had SCD. Kaplan–Meier analysis showed that SCD was observed significantly more frequently in patients with ERP than in those without ERP (63% [10/16] vs 14% [16/116], P < 0.0001]. A multivariate Cox analysis revealed that ERP was significantly and independently associated with SCD (hazard ratio, 3.7; 95% confidence interval, 1.6–8.6; P = 0.002).
ERP in inferior leads would be associated with an increased risk of SCD in CHF patients.