title: Benign vs. malignant inferolateral early repolarization: Focus on the T wave.
abstract: BACKGROUND
  Inferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER.
  
  
  METHODS
  We compared the ECGs of patients with ER and VF (n = 92) with control subjects with asymptomatic ER (n = 247). We assessed J-wave amplitude, QTc interval, T-wave/R-wave (T/R) ratio in leads II and V5, and presence of low-amplitude T waves (T-wave amplitude <0.1 mV and <10% of R-wave amplitude in lead I, II, or V4-V6).
  
  
  RESULTS
  Compared to controls, the VF group had longer QTc intervals (388 ms vs. 377 ms, P = .001), higher J-wave amplitudes (0.23 mV vs. 0.17 mV, P <.001), higher prevalence of low-amplitude T waves (29% vs. 3%, P <.001), and lower T/R ratio (0.18 vs. 0.30, P <.001). Logistic regression analysis demonstrated that QTc interval (odds ratio [OR] per 10 ms: 1.15, 95% confidence interval [CI} 1.02-1.30), maximal J-wave amplitude (OR per 0.1 mV: 1.68, 95% CI 1.23-2.31), lower T/R ratio (OR per 0.1 unit: 0.62, 95% CI 0.47-0.81), presence of low-amplitude T waves (OR 3.53, 95% CI 1.26-9.88). and presence of J waves in the inferior leads (OR 2.58, 95% CI 1.18-5.65) were associated with malignant ER.
  
  
  CONCLUSIONS
  Patients with malignant ER have a higher prevalence of low-amplitude T waves, lower T/R ratio (lead II or V5), and longer QTc interval. The combination of these parameters with J-wave amplitude and distribution of J waves may allow for improved identification of malignant ER.
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France; Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: laurent.roten@insel.ch.
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Saagar
authors.initials: S
authors.lastname: Mahida
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pascale
authors.affiliation: Département de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, AP-HP, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Leenhardt
authors.affiliation: Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Jesel
authors.affiliation: Deutsches Herzzentrum München, München, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.affiliation: Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.affiliation: L׳institut du thorax, service de cardiologie du CHU de Nantes, Nantes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.affiliation: Department of Cardiology, Toulouse University School of Medicine, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.affiliation: CTU Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daly
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: CHU de Bordeaux/IHU Institut de Rythmologie et Modélisation Cardiaque, Université Bordeaux/Inserm U1045, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
keywords: Early repolarization; Electrocardiogram; J wave; QT interval; Ventricular fibrillation