Benign vs malignant inferolateral early repolarization: Focus on the T wave

BackgroundInferolateral early repolarization (ER) is highly prevalent and is associated with idiopathic ventricular fibrillation (VF).ObjectiveThe purpose of this study was to evaluate the potential role of T-wave parameters to differentiate between malignant and benign ER.MethodsWe 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).ResultsCompared 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.ConclusionPatients 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.