Characteristics of “malignant” vs. “benign” electrocardiographic patterns of early repolarization

•Various ECG patterns of early repolarization•Magnitude of risk in different early repolarization phenotypes•Markers of benign and more severe nature for risk assessment

The electrocardiographic (ECG) pattern of early repolarization (ER) has historically been regarded as a benign ECG variant, but during the past few years, this concept has been challenged based on multiple reports linking the ER pattern with an increased risk of sudden cardiac death. Although the mechanistic basis of ventricular arrhythmogenesis in patients with ER pattern is still incompletely understood, there is increasing information about the ECG and phenotype characteristics of “malignant” vs. “benign” patterns of ER. This review presents the current evidence of markers of “benign” and a more severe nature of ER.