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Heart of a Champion: Early Repolarization and Risk for Sudden Cardiac Death in Elite Athletes

Summary and Comment |
October 24, 2013

Heart of a Champion: Early Repolarization and Risk for Sudden Cardiac Death in Elite Athletes

  1. Mark S. Link, MD

In a small cohort of professional soccer players, J-point elevation was common and did not portend sudden cardiac death during long-term follow-up.

  1. Mark S. Link, MD
Morphologies of QRS-ST Transitions
A) Early repolarization without J wave; B) notched J wave with ascending ST segment; C) notched J wave with horizontal/descending ST segment; D) slurred J wave with ascending ST segment; E) slurred J wave with horizontal/descending ST segment.

Reprinted with permission from Biasco L et al. Clinical, electrocardiographic, echocardiographic characteristics and long term follow up of elite soccer players with J point elevation. Circ Arrhythm Electrophysiol 2013 Oct 4; [e-pub ahead of print].
Morphologies of QRS-ST Transitions

A) Early repolarization without J wave; B) notched J wave with ascending ST segment; C) notched J wave with horizontal/descending ST segment; D) slurred J wave with ascending ST segment; E) slurred J wave with horizontal/descending ST segment.

Reprinted with permission from Biasco L et al. Clinical, electrocardiographic, echocardiographic characteristics and long term follow up of elite soccer players with J point elevation. Circ Arrhythm Electrophysiol 2013 Oct 4; [e-pub ahead of print].

Early repolarization is more common in trained athletes than in the general population and has for decades been considered a benign finding. Recent reports have challenged this view; in particular, findings from a 2008 study demonstrated that a high percentage of survivors of idiopathic ventricular fibrillation have electrocardiographic (ECG) evidence of early repolarization (NEJM JW Cardiol May 14 2008). However, the definition of early repolarization in that study encompassed slurred terminal QRS and notched J waves (see figure) — findings not included in the classic definition of early repolarization.

In a new retrospective analysis of ECG findings and outcomes in 332 professional soccer players, early repolarization was identified in 36% during their playing years in Italy. Patient characteristics significantly associated with early repolarization were black race, slower heart rate, left ventricular hypertrophy, and greater interventricular thickness. Ninety-five of the 118 early repolarizations were classically defined, with J-point elevation and a concave, upward-sloping ST segment; the rest showed some degree of terminal QRS slurring or notched J waves. During long-term follow-up (median, 13.3 years), no cardiovascular deaths occurred.

Comment

The definition of early repolarization is critical in interpreting these findings. Consistent with most studies, traditionally defined early repolarization was common and not associated with increased risk for sudden cardiac death (SCD). QRS slurring or J-wave notching was less common in these highly trained athletes than in survivors of idiopathic ventricular fibrillation; whether such patterns predict SCD in the general population cannot be deduced from these results, but these data do support a benign prognosis for all types of J-point elevation in young athletes.

  • Disclosures for Mark S. Link, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Heart Association (Chair, Core 4; Scientific Sessions)

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