title: Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training.
abstract: BACKGROUND
  Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes.
  
  
  RESULTS
  ERP was assessed in a cross-sectional cohort of collegiate athletes (n = 879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n = 146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61; P < 0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52; P < 0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87; P < 0.001).
  
  
  CONCLUSIONS
  Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.forename: Rory
authors.initials: R
authors.lastname: Weiner
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kim
authors.forename: Varsha
authors.initials: V
authors.lastname: Keelara
authors.forename: Francis
authors.initials: F
authors.lastname: Wang
authors.forename: Brant
authors.initials: B
authors.lastname: Berkstresser
authors.forename: Malissa J
authors.initials: MJ
authors.lastname: Wood
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Adolph M
authors.initials: AM
authors.lastname: Hutter
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton-Cheh
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D056352:Athletes; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology