The Early Repolarisation pattern in athletes: Definitions and prognostic significance

Dr Michael Papadakis, Sports Cardiology Quiz Section Editor

20 Nov 2014

Prof. Sanjay Sharma , FESC

Prof. Michael Papadakis , FESC

Dr. Greg Mellor

The case

Description

A 32 year-old, male, Caucasian professional cyclist attended for routine pre-participation screening as mandated by the Union Cycliste International (UCI).
He was asymptomatic and had no family history of sudden death or of cardiac pathology.
He trained for 30 hours per week.

His 12 lead ECG is shown below:

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.

References

[*1] Sudden cardiac arrest associated with early repolarization.
Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, Roy L de, Pasquié J-L, Nogami A, Babuty D, Yli-Mayry S, Chillou C De, Scanu P, Mabo P, Matsuo S, Probst V, Scouarnec S Le, Defaye P, Schlaepfer J, Rostock T, Lacroix D, Lamaison D, Lavergne T, Aizawa Y, Englund A, Anselme F, O’Neill M, Hocini M, Lim KT, Knecht S, Veenhuyzen GD, et al.
N Engl J Med. 2008;358:2016–2023.
[*2] Long-term outcome associated with early repolarization on electrocardiography.
Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen H a, Reunanen A, Huikuri H V. N Engl J Med. 2009;361:2529–2537.
[*3] Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome.
Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T, Sager SJ, Rissanen H a, Myerburg RJ, Reunanen A, Huikuri H V. Circulation. 2011;123:2666–2673.
[*4] Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study.
Sinner MF, Reinhard W, Müller M, Beckmann B-M, Martens E, Perz S, Pfeufer A, Winogradow J, Stark K, Meisinger C, Wichmann H-E, Peters A, Riegger G a J, Steinbeck G, Hengstenberg C, Kääb S. (MONICA/KORA). PLoS Med. 2010;7:e1000314.
[*5] Prevalence, prognosis, and identification of the malignant form of early repolarization pattern in a population-based study.
Rollin A, Maury P, Bongard V, Sacher F, Delay M, Duparc A, Mondoly P, Carrié D, Ferrières J, Ruidavets J-B. Am J Cardiol. 2012;110:1302–1308.
[*6] Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training.
Noseworthy P a, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, Wood MJ, Wang TJ, Picard MH, Hutter AM, Newton-Cheh C, Baggish AL. Circ Arrhythm Electrophysiol. 2011;4:432–440.
[*7] Recommendations for interpretation of 12-lead electrocardiogram in the athlete.
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjørnstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes N a M, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, et al. Eur Heart J. 2010;31:243–259.

Notes to editor

Dr Greg Mellor, Cardiology research fellow, St George’s university of London
Dr Michael Papadakis, Lecturer in cardiology, St George’s university of London
Prof Sanjay Sharma, Professor of clinical cardiology, St George’s university of London

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