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Early Repolarization Variant in Syncopal Patients Referred to Tilt Testing


  • This work was supported by the Medical University of Lodz grant (502-03/1-005-02/502-14-081) to Anna Bartczak.

  • Conflict of interest: None declared.

Address for reprints: Malgorzata Lelonek, M.D., Ph.D., Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Sterling Str. 1/3, 91-425 Lodz, Poland. Fax: 48 42 6364471; e-mail:



Early repolarization variant (ERV) was recently described as an electrocardiogram (ECG) pattern associated with increased risk of sudden cardiac death (SCD) in some populations. We decided to establish the significance of ERV in syncopal patients referred to tilt testing due to suspected reflex syncope.


From 160 consecutive patients (mean age 36.6 ± 15 years) history of syncopal episodes and resting ECG were collected. ERV was diagnosed if elevation of point J ≥0.1 mV was in ≥2 ECG leads II, III, aVF and/or I, aVL, V4–V6. Analysis was performed in regard to ERV and degree of J-point elevation (JPE; ≥2 mV vs <2 mV). Patients were at 2 years follow-up.


ERV was present in 31% of patients. The most frequent was the ascending ST elevation variant (84%) and lateral ECG locations (74%). The degree of JPE did not differentiate the studied patients. Male sex was associated with the higher risk of ERV (odds ratio [OR] = 2.84; P = 0.003). ERV in inferior ECG leads enhanced the risk of positive tilt testing (OR = 3.57; P = 0.048). There was no relationship between ERV and injuries or syncopal history. No deaths were observed in follow-up.


Among middle-aged people referred to tilt testing due to suspected reflex syncope the ascending ST elevation type was the most frequent variant of ERV and in midterm follow-up there were no deaths. In this population ERV was frequent and associated with positive tilt testing. According to recently described higher risk of SCD among people with ERV, we need further studies and longer follow-up to establish the clinical importance of ERV in patients with reflex syncope.