title: Early repolarization increases the occurrence of sustained ventricular tachyarrhythmias and sudden death in the chronic phase of an acute myocardial infarction.
abstract: BACKGROUND
  We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI.
  
  
  RESULTS
  This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences.
  
  
  CONCLUSIONS
  ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death.
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Naruse
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.). htada@u-fukui.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Harimura
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Mayu
authors.initials: M
authors.lastname: Ishibashi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Noguchi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000200:Action Potentials; D000368:Aged; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: acute myocardial infarction; arrhythmia; death, sudden, cardiac; early repolarization