Abstract 17825: Prevalence of Early Repolarization Pattern in Patients With Atrial Fibrillation
Introduction: The early repolarization (ER) pattern has been identified in sudden death survivors and may reflect a genetic predisposition to malignant ventricular arrhythmias. In a preliminary study, ER pattern has also been identified in young patients with atrial fibrillation (AF), but this association has not been rigorously tested. The purpose of this study is to determine the prevalence of ER in young and middle aged patients with AF, using newly proposed diagnostic criteria for ER.
Methods: A case-control study was conducted to compare 182 patients with AF, age <60 and without structural heart disease, compared to control patients without AF. Groups were matched for gender (160 male and 22 female in each group). Electrocardiograms were blindly assessed by 2 investigators for ER pattern based on recently published criteria for notching and slurring of the terminal QRS exceeding 1 mm in the lateral precordial, inferior, or lateral limb leads. In cases of disagreement, a 3rd investigator adjudicated the classification.
Results: The kappa statistic for agreement between two investigators was 0.72 (95% CI 0.63-0.81). AF patients were older than controls (46±10 vs 40±12, p<0.0001). There was no difference between groups in the frequency of left ventricular hypertrophy (LVH) by Sokolow-Lyon or Cornell criteria. After adjudication, the ER pattern was identified in 30/182 (16%) AF patients and 37/182 (20%) controls (p=0.34). If a more stringent J-peak criterion of 2 mm was used, no difference was found between the two groups. A sub-analysis of patients ≤50 years also demonstrated no difference in frequency of ER pattern. ER was found in 27/160 male AF and 36/160 male control patients (17% vs 23%, p=0.26). An age-matched analysis of 84 patients also showed no difference in ER prevalence between the groups. ER pattern was more common in patients with LVH by Sokolow-Lyon voltage criteria (16/29 vs 51/335, 55% vs 15%, p<0.0001) and tended to be more common in men (4/44 vs 63/320, 9% vs 20%, p=0.10).
Conclusions: In contrast to previously published data, ER pattern is not more common in patients with AF. Using newly proposed consensus criteria, ER can be identified in approximately 20% of young adult and middle aged men and is more common in patients with voltage criteria for LVH.
Author Disclosures: P.W. McNair: None. D.M. Benenson: None. J.E. Ip: None. G. Thomas: Research Grant; Modest; Biotronik. Speakers Bureau; Modest; Biotronik, St Jude Medical, Medtronic. J.W. Cheung: Research Grant; Modest; Biotronik. Honoraria; Modest; Medtronic, Biotronik. C.F. Liu: Honoraria; Modest; St Jude Medical. B.B. Lerman: None. S.M. Markowitz: Honoraria; Modest; Boston Scientific.
- © 2016 by American Heart Association, Inc.